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Pulmonary Function Testing
Good for the patient - good to increase your reimbursement.
Pulmonary function testing is testing that should be done in house. Have you ever stopped to think about how many active smokers you have in your practice. Probably one third of the people you see in one day, in your office, are smokers and need pulmonary function testing. What about those that have “quit” but are now having chronic lung problems.
Pulmonary function may give you some direction for treatment. Let us face it, nicotine addiction is a killer. It kills off lung tissue, it caused pulmonary fibrosis, and it sets the stage for chronic bronchitis. It stimulates adrenalin formation and cortisol formation – both of which contribute to atherosclerotic plaque formation.
You have to find a way to break this nicotine addiction. I have found that you can talk until you are blue in the face and it does not do any good. As part of our pulmonary function testing, we do peak flow meter determination first, without a bronchodilator inhaler, then on the second go around, we peak flow them after bronchodilator inhalations.
When I can show them that they were supposed to do 750 on the test and they produced 300 on the test….I can tell them and show them what they are doing to their lungs. When I say your vital capacity is reduced by 450, they get the pitch. Then after formal pulmonary function testing when I show them the report that says “moderate airway obstruction,” I tell them, “You’ve got a chance.” If this report had said “Severe airway obstruction:, you would have been on a progressive downhill course”.
Then I say – “Do you remember seeing these people in restaurants and in other places with oxygen masks and tubing hooked to an oxygen canister which they pull behind them on a little two-wheel carrier? They do this to stay alive. This is what will happen to you unless you stop smoking.”
In our quest to help them, we employ the nicotine patches in a decreasing order. 21 mg patch daily for one month, then a 14mg patch daily for the second month, and a 7mg patch daily for the last 28 days. We also give them Zyban or Wellbutrin, to help them in their quest to quit. We see them monthly for their medical-surgical problems, and for manipulative medicine and smoking addiction – all the time offering positive cessation suggestions for their subconscious mind to work on.
Our programs have been successful by employing peak flow meter performance in conjunction with formal pulmonary function to jolt the patient into reality as to the need to stop smoking Pulmonary function machines are available on the Internet and through medical equipment supply companies.
Pick a machine that will give you a printout that says normal spirometry or “minimal” obstructive airway disease, or severe obstructive airway disease. The patient does not understand fev, and terms that are on the report. What they do understand is when the report says, “Your lungs are in big trouble (severe airway obstructive disease.)
When you go to buy your pulmonary function equipment, always find out if there is a “demonstrator” available at a reduced price, or a “reconditioned” model with a one year warranty at a reduced price. Pulmonary function testing – good for the patient – good for reimbursement. Medicaid and Medicaid pay $55.00 private pay insurance companies (Blue Cross/Blue Shield Etc.) pay $80.00.
