AI claim scrubber for pulmonology billing
Syntra checks PFT and bronchoscopy documentation for bronchodilator testing, biopsies, and separate diagnostic components before the claim is billed. Syntra is an AI claim and chart scrubber that reviews pulmonology documentation against the claim before submission, so billing teams prevent denials instead of working them.
Example capture
94060 · Bronchodilation responsiveness spirometry
PFT report includes pre- and post-bronchodilator spirometry with a documented response. Supports reporting 94060.
What causes pulmonology claim denials?
Most pulmonology denials trace back to the chart: a service documented but not coded, a code the note does not support, or a modifier that is missing. These are the patterns Syntra checks on every pulmonology encounter before submission:
- Spirometry billed without the pre- and post-bronchodilator documentation that supports 94060
- Bronchoscopy with biopsy or EBUS components omitted from the claim
- Sleep and PFT interpretation billed without a signed report
Which pulmonology modifiers and edits does Syntra check?
Syntra applies NCCI (CCI) edits, MUEs, and payer rules, then confirms each modifier is supported by the documentation rather than added to get past an edit. Common pulmonology modifiers it validates:
- -26 / -TC for interpretation splits
- -59 for distinct bronchoscopic procedures
- -25 on E/M with same-day testing
Payers expect test-level documentation of medical necessity for repeat PFTs and sleep studies.
Those checks follow public payer rules, including CMS National Correct Coding Initiative (NCCI) edits and Medicare Coverage Database (LCDs and articles). Syntra applies the rule to the note, which a claim-only edit cannot see.
How is this different from pulmonology billing software or a clearinghouse scrubber?
Billing software, practice-management systems, and clearinghouses scrub the claim after it is built: required fields, code pairs, and payer edits. They usually cannot see the clinical note. Syntra reasons on the note and the claim together, the way an experienced pulmonology coder would, which is how it finds undercoding and compliance risk that claim-level rules pass through. It sits on top of your existing revenue cycle management (RCM) stack rather than replacing it.
Read more on how Syntra differs from EHR scrub rules and clearinghouse claim scrubbers.
Pulmonology claim scrubber FAQs
- What is the best claim scrubber for pulmonology practices?
- The best pulmonology claim scrubber reads the chart, not only the claim. Syntra is an AI claim and chart scrubber that compares pulmonology documentation to the codes, modifiers, and payer rules before submission, so missed revenue and denial risk are caught while the encounter can still be corrected.
- How does Syntra reduce pulmonology claim denials?
- Syntra checks every encounter for the denial drivers common in pulmonology, including NCCI bundling, missing or incorrect modifiers, medical necessity, and global-period conflicts. It flags issues before the claim leaves the practice, which raises the clean claim rate instead of working denials after the fact.
- Does Syntra replace my pulmonology billing software or EHR?
- No. Syntra sits on top of your existing EHR, practice-management system, and clearinghouse. It adds chart-level pre-bill review to the revenue cycle (RCM) stack you already run.
- Which EHRs does Syntra support for pulmonology?
- Syntra integrates with Epic, Cerner, NextGen, Nextech, SIS, iMedicWare, athenahealth, eClinicalWorks, Optivate, and ModMed. If your pulmonology practice uses another EHR, a dedicated engineer builds a custom integration.
- How do pulmonology practices get started?
- Every practice starts with a complimentary retroactive audit of recent pulmonology charts and claims. Syntra then moves to controlled pre-bill review and, over about 90 days, autonomous submission on eligible encounters with humans in the loop.
See other specialties, EHR integrations, or how pre-bill review works.
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