Pulmonary Function Tests (PFTs) for Health Care Professionals

Pulmonary function tests (PFTs), including spirometry, lung volumes, diffusing capacity, and airway resistance, are breathing tests led by a trained pulmonary function technologist, usually done at a hospital or clinic, but increasingly done at a physician’s office. This page is designed to help a health care professional understand the basics of pulmonary function tests, and find additional helpful resources.

Patient-level information on PFTs

Asthma Diagnosis

The Expert panel recommends that spirometry measurements—FEV1, FVC, FEV1/FVC%—before and after the patient inhales a short-acting bronchodilator should be undertaken for patients in whom the diagnosis of asthma is being considered, including children ≥5 years of age. PFTs are also recommended for assessing asthma severity. Obstruction is assessed with FEV1/FVC% and severity with FEV1 for adults and children. A lower limit of normal (LLN) is commonly utilized and considered during diagnosis and monitoring. Percent predicted should not be used in adults or pediatrics.

The National Institute for Occupational Safety and Health (NIOSH) provides NHANES lll reference values for FEV1, FEV6, FVC, PEF, FEF25-75, FEV1/FVC, and FEV6/FVC. The Global Lung Function Initiative (GLI) has many great resources, including educational materials to help inform health professionals and patients about the GLI equations, and what they can expect when pulmonary function laboratories switch to using the GLI.

Asthma Monitoring

The Expert panel recommends annual spirometry to track disease severity and monitor medication efficacy. When office spirometry shows severe abnormalities, or if questions arise regarding test accuracy or interpretation, further assessment should be performed in a specialized pulmonary function laboratory. All testing should be completed in accordance with ATS/ERS Spirometry Standards.

Coding & Billing

Taking the time to do PFTs well is important, and billing for your time can help make that happen. To learn more, the ATS Coding & Billing Quarterly newsletter summarizes key information on coding, billing, documentation and regulation policy changes that are relevant to clinicians in respiratory, critical care and sleep medicine. The quarterly publication covers issues such as new CPT and ICD-9-CM codes, changing CPT and ICD-9-CM nomenclature and numbering, regulatory policies and Medicare coverage of pulmonary patients.

PFT Resources

American Thoracic Society/European Respiratory Society PFT Statements and Guidelines

American Thoracic Society/European Respiratory Society PFT statements and guidelines are based upon a systematic review or pragmatic evidence synthesis, and describe how to perform a test or procedure and describe the underlying evidence. These are the accepted global standards for pulmonary testing in all settings.

Setting the standards for PFTs the new ATS Pulmonary Function Laboratory Management and Procedure Manual 3rd Edition e-book with PDF download is now available.
All pulmonary function testing should use equipment and follow the protocol of the American Thoracic Society. The technologist administering the test should have completed an accredited training course such as one approved by the National Institute for Occupational Safety and Health. To choose the best spirometer for your office, look for one that:

meets compliance with American Thoracic Society (ATS) performance standards
satisfies specific NIOSH requirements regarding the content of spirometry test reports;
produces output data in standardized electronic spirometry data file format by February 2018.

Spirometry 360/Spirometry 360 Express

Spirometry 360/Spirometry 360 Express offers comprehensive, interactive, and evidence-based online programs to train test administrators and clinical interpreters to perform and interpret high-quality spirometry tests. Each course is designed to fit into your team’s busy schedule by allowing you to complete the material at your own pace.

Spirometry Webinars

The Michigan Department of Health & Human Services Childhood & Adolescent Health Centers Program created spirometry webinars to help improve technique in performing and interpreting PFTs.