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How to Use AI for a Pulmonology Practice in 2026: COPD/Asthma, PFT, Sleep, ILD, Lung Cancer Screening & Owner Scorecard

Published 2026-05-22 · 17 min read

TL;DR — Pulmonology Practice AI Stack (2026)

Run ambient-scribed SOAP (DeepScribe, Abridge, Suki, Heidi, Nuance DAX Copilot, Freed, Sunoh.ai) with CPT 94xxx coding. Layer AI PFT/spirometry/DLCO pre-read (MGC BreezeSuite, ndd EasyOne, Vyaire SentrySuite, Morgan ComPAS) — pulmonologist signs final. Add LDCT nodule-detection + Lung-RADS AI (Optellum Virtual Nodule Clinic, Riverain ClearRead CT, Aidoc, Imbio LDA) with USPSTF 2021 + CMS NCD 210.14 compliance. Automate OSA HSAT scoring (NightOwl, WatchPAT, ApneaLink, Alice NightOne, Nox T3) + CPAP adherence (ResMed AirView, Philips DreamMapper) under AASM 2023 + CMS 90-day 4-hr/70% rule. Biologic prior-auth automation for Dupixent/Tezspire/Fasenra/Nucala/Xolair with GINA 2024 + GOLD 2025 + step-therapy appeal. Never let AI diagnose, finalize PFT/CT/HSAT, prescribe controlled substances, sign CMN 484.03 oxygen, or handle PHI without BAA. The one owner number: biologic-eligible patients on-therapy within 30 days of indication.

The Pulmonology AI Stack (2026)

LayerToolsOwner outcome
Ambient SOAP + codingDeepScribe, Abridge, Suki Assistant, Heidi, Nuance DAX Copilot, Freed, Sunoh.ai, Nabla, Augmedix1.5-2 hr/day/MD reclaimed
PFT + spirometry + DLCO + CPETMGC Diagnostics BreezeSuite AI, ndd Medical EasyOne AI, Vyaire SentrySuite, Morgan Scientific ComPAS, COSMED Omnia, Jaeger MasterScreen55-70% faster interpretation TAT
LDCT + chest imaging AIOptellum Virtual Nodule Clinic, Riverain ClearRead CT, Aidoc Pulmonary, Imbio LDA, ClearRead, Siemens AI-Rad Companion, GE Edison, Canon AltivityLung-RADS concordance + faster read
OSA HSAT + CPAP adherenceNightOwl, Itamar WatchPAT, ResMed ApneaLink, Philips Alice NightOne, Nox T3, ResMed AirView, Philips DreamMapper, Fisher & Paykel SleepStyle, Lowenstein SleepDocCMS 90-day 4-hr/70% on autopilot
Biologic prior-authCoverMyMeds, Myndshft, Glidian, Availity Essentials, Waystar AuthorizationPlus, Rhyme, Olive AI + GINA 2024/GOLD 2025 templates40-55% lower denials + faster TAT
Patient engagement + recallWeave AI, Doctible, NexHealth, Solutionreach, Phreesia AI, RevenueWell, Klara, Klara AssistantNo-show + recall on autopilot
EHR + practice managementEpic Pulmonology + Haiku, Oracle Cerner Millennium, athenaOne Pulmonology, eCW, NextGen, Meditech Expanse, Modernizing Medicine EMA PulmonologyWorkflow backbone

10 Copy-Paste Prompts for a Pulmonology Practice

Every prompt assumes (a) a board-certified pulmonologist signs the final output, (b) no PHI is pasted into a consumer-grade LLM, and (c) AI vendors have a signed BAA under 45 CFR 164.502(e) + 164.504(e).

1) New-patient pulmonary intake synthesis

You are the intake nurse at [PRACTICE]. Given this new referral packet (PCP referral reason, HPI, PMH, medications, allergies, smoking pack-years + quit date, occupational + environmental exposures, prior PFT/CT/sleep studies, vaccine history PPSV23/PCV15/PCV20/Tdap/flu/COVID/RSV): synthesize (a) a one-page pulmonary pre-visit note with top 3 working differentials, (b) recommended pre-visit orders (PFT + DLCO, CXR/HRCT/LDCT, ABG, 6MWT, ECG, echo, CPET) per GOLD 2025 / GINA 2024 / ATS/ERS standards, (c) red-flag escalation criteria (massive hemoptysis, hypoxia < 90% on RA, suspected PE with Wells > 4 + elevated D-dimer, suspected lung mass + weight loss), (d) questions the MD should ask first, (e) LDCT eligibility per USPSTF 2021 + CMS NCD 210.14, (f) social + insurance + biologic-coverage screen. Do not make a diagnosis — this is pre-visit prep only.

2) Ambient pulmonology SOAP with CPT 94xxx coding

From this visit transcript, produce a full pulmonology SOAP. S = CC + HPI with OLDCARTS + pack-year delta + exposure + inhaler technique + CAT/ACT/mMRC + Epworth + STOP-BANG as relevant. O = vitals + SpO2 RA/on O2 + lung exam + cor pulmonale screen + relevant PFT/imaging/sleep-study summary. A = ICD-10 with J44.x COPD + J45.x asthma + J84.x ILD + G47.3x OSA + C34.x lung ca + J96.x resp failure + B34.x post-COVID + R09.x cough/dyspnea. P = GOLD 2025 ABE group for COPD / GINA 2024 step for asthma / ATS OSA therapy / ILD multidisciplinary referral as appropriate + inhaler + LABA/LAMA/ICS + biologic eligibility + pulmonary rehab CPT 94625/94626 + smoking-cessation CPT 99406/99407 + O2 evaluation + follow-up. Suggest CPT 99202-99215 E/M + 94010/94060/94726/94727 PFT-DLCO + 94620/94621 CPET-6MWT + 94667/94668 chest PT + G0302-G0305 pulmonary rehab + 95782-95811 sleep + time-based add-ons. Flag for pulmonologist sign-off — do not auto-submit to EHR.

3) PFT/spirometry/DLCO AI pre-read

Given this PFT report (pre + post bronchodilator spirometry, lung volumes by plethysmography or helium dilution, DLCO, MIP/MEP, FeNO if available): produce a first-pass interpretation mapped to ATS/ERS 2022 standards. Include (a) quality grade A-F per ATS/ERS test acceptability + repeatability criteria, (b) pattern classification obstructive / restrictive / mixed / nonspecific / normal with z-score + % predicted, (c) severity grading per GLI 2012 reference, (d) bronchodilator response (≥ 10% of predicted FEV1 or FVC per 2022 update, NOT the old 12% + 200 mL), (e) DLCO/KCO interpretation + hemoglobin correction, (f) lung-volume pattern hyperinflation/restriction, (g) clinical correlation suggestion COPD/asthma/ILD/NMD/obesity/PVD. Flag quality issues for repeat. Format as a draft report for the pulmonologist to finalize — never finalize without physician signature per CPT 94010/94726/94727 professional-component documentation.

4) LDCT lung-cancer-screening triage + Lung-RADS

For this LDCT screening patient: (a) verify USPSTF 2021 eligibility — age 50-80, ≥ 20 pack-years, current smoker or quit within 15 years, asymptomatic, able to tolerate curative surgery + (b) verify CMS NCD 210.14 requirements — documented shared-decision-making visit CPT G0296 for Medicare initial screen, radiology-facility ACR Lung Cancer Screening Registry, radiologist LCSR participation, smoking-cessation counseling documented, (c) pull AI nodule detection from Optellum/Riverain ClearRead CT/Aidoc Pulmonary/Imbio LDA/Siemens AI-Rad Companion, (d) suggest Lung-RADS 1.1 category 1/2/3/4A/4B/4X with follow-up interval, (e) draft patient-facing plain-English result letter including nodule description + next step + reassurance + smoking-cessation referral, (f) flag any nodule requiring PET-CT or tissue sampling for MD review. Never finalize the Lung-RADS category — radiologist/pulmonologist sign-off required.

5) COPD + asthma care plan (GOLD 2025 + GINA 2024)

Given this COPD or asthma patient snapshot (spirometry, CAT/ACT, mMRC, exacerbations last 12mo, eosinophil count, FeNO, IgE, current inhaler + adherence + technique, comorbidities, vaccines): produce a 2026 care plan. For COPD: GOLD 2025 ABE group A/B/E inhaler ladder LAMA → LAMA+LABA → triple LAMA+LABA+ICS if eos ≥ 300 or ≥ 2 moderate exacerbations or 1 hospitalization, biologic eligibility ensifentrine / dupilumab type-2 COPD + eos ≥ 300, pulmonary rehab G0302-G0305, O2 evaluation if SpO2 ≤ 88% RA, vaccines, smoking cessation. For asthma: GINA 2024 step 1-5 with MART/SMART ICS-formoterol, biologic eligibility Dupixent (type-2 high, FeNO ≥ 20 or eos ≥ 150) / Tezspire (any phenotype) / Fasenra (eos ≥ 300) / Nucala (eos ≥ 150) / Xolair (perennial allergen + IgE 30-1500). Output (i) inhaler prescription + technique video + spacer, (ii) action plan with green/yellow/red zones, (iii) biologic prior-auth kickoff list, (iv) follow-up interval. Pulmonologist signs.

6) OSA HSAT scoring + CPAP prescription + adherence

Given this HSAT raw study (NightOwl / WatchPAT / ApneaLink / Alice NightOne / Nox T3) + pre-test STOP-BANG + Epworth + BMI + neck circumference + comorbidities: produce (a) AASM 2023-scored AHI / RDI / ODI / mean SpO2 / % time SpO2 < 90% / supine vs non-supine delta, (b) OSA severity none/mild/moderate/severe, (c) recommendation for CPAP vs APAP vs BiPAP vs oral appliance vs positional therapy vs Inspire UAS eligibility, (d) CPAP initial pressure setting (APAP 5-15 cm H2O default, titrate), (e) six-element DME order per CMS LCD + Medicare Documentation Requirements, (f) patient education packet + desensitization plan + mask-fit decision, (g) 30/60/90-day follow-up schedule with ResMed AirView / Philips DreamMapper adherence pull for CMS 90-day 4-hr/night 70% compliance rule. Flag any central apnea > 5/hr or Cheyne-Stokes for MD re-review. Never diagnose — MD signs the interpretation. In-lab PSG (CPT 95810/95811) required if HSAT negative and suspicion remains high.

7) ILD + sarcoidosis multidisciplinary workup

For this suspected ILD patient (HRCT pattern, PFT restrictive, DLCO reduced, autoimmune panel, occupational + drug exposure, 6MWT desaturation): produce (a) differential across IPF / HP / NSIP / CTD-ILD / sarcoidosis / PLCH / LAM / drug-induced / occupational, (b) HRCT pattern classification UIP / probable UIP / indeterminate / alternative per 2022 ATS/ERS/JRS/ALAT guideline, (c) recommended additional workup BAL + TBLC + surgical lung biopsy vs non-invasive with MDD, (d) antifibrotic eligibility pirfenidone or nintedanib for IPF or PPF (progressive pulmonary fibrosis per 2022 guideline), (e) sarcoidosis staging CXR 0-IV + organ-specific involvement + initial prednisone vs methotrexate vs infliximab, (f) pulmonary-rehab + O2 + lung-transplant-referral thresholds FVC < 50% or DLCO < 35% or rapid decline, (g) draft MDD memo for the pulmonology-radiology-pathology conference. Never finalize an ILD diagnosis without MDD sign-off — guideline standard of care.

8) Biologic prior-auth + step-therapy appeal (Dupixent/Tezspire/Fasenra/Nucala/Xolair)

Draft a biologic prior-authorization packet for [PATIENT] for [DUPIXENT/TEZSPIRE/FASENRA/NUCALA/XOLAIR] for [ASTHMA/CRSwNP/EOE/AD/COPD]. Pull from the chart: diagnosis + ICD-10, spirometry + reversibility, eosinophil count (≥ 150 or ≥ 300 per drug), IgE (Xolair), FeNO, exacerbation history (≥ 2 moderate or 1 hospitalization prior 12mo), step-therapy exposure (medium-high ICS + LABA + LAMA for asthma ≥ 3 mo), adherence documented, contraindications ruled out. Output (a) payer-specific letter mapped to Milliman MCG + InterQual + FDA-approved indication + GINA 2024 step + GOLD 2025 + NCCN/ACR/AAD compendium, (b) attach PFT + labs + visit notes, (c) preempt step-therapy denial with documented failure/intolerance, (d) if denied draft peer-to-peer + formal appeal referencing 45 CFR 147.136 ACA external review + state insurance dept. Never submit — pulmonologist signs + MA submits through payer portal.

9) HIPAA-safe recall + CPAP adherence + LDCT annual

Draft a HIPAA-safe multi-channel recall campaign (portal + SMS + email + voice) for: (a) COPD patients overdue PFT annual or exacerbation 6-mo follow-up, (b) asthma patients overdue ACT or biologic infusion/injection, (c) OSA patients in 30/90-day CPAP adherence window, (d) LDCT annual per USPSTF + CMS NCD 210.14, (e) ILD patients due PFT/DLCO q3-6mo + HRCT yearly, (f) lung-cancer-screening + tobacco-cessation quitline referral. Messages must be minimum-necessary per 45 CFR 164.514 — no diagnosis or medication in outbound SMS beyond "your pulmonology team", TCPA opt-in captured at intake, quiet hours 8am-9pm local, STOP/HELP. Do not include PHI in unencrypted channels — route to patient portal when content requires any PHI.

10) Owner monthly scorecard

Given this month's P&L + EHR + PFT-lab + sleep-lab + biologic-infusion KPI pull, produce a one-page owner scorecard: biologic-eligible patients on-therapy within 30 days of indication (the one number), new-patient volume by referral source, PFT + DLCO volume + turnaround, LDCT volume + Lung-RADS distribution, HSAT volume + CPAP 90-day adherence rate, biologic prior-auth approval rate + TAT, denial rate + appeal win rate, E/M level distribution 99213/99214/99215, RVU per MD per day, no-show rate, AR over 60/90, net collection %, CAHPS patient experience, MIPS MVP performance, referral-source concentration risk. Surface top 3 leveraged actions for next month.

Compliance Floor — Non-Negotiable

The 60-Day Rollout

  1. Days 1-7 — audit EHR, PFT lab (MGC/ndd/Vyaire/Morgan), sleep lab (Natus SleepWorks, Compumedics Profusion, Philips Sleepware G3), DME + biologic-infusion workflow; sign BAAs with AI vendors; document HIPAA + state AI consent language.
  2. Days 8-14 — stand up ambient scribe (DeepScribe/Abridge/Suki/DAX/Heidi/Freed/Sunoh.ai); pilot on 5 MD × 10 visits; measure documentation time delta + coding accuracy.
  3. Days 15-21 — roll out AI PFT/DLCO pre-read; pulmonologist signs every report; baseline interpretation TAT.
  4. Days 22-28 — deploy LDCT AI + Lung-RADS pipeline (Optellum/Riverain/Aidoc/Imbio); confirm CMS NCD 210.14 + ACR LCSR + CPT G0296 workflow; pilot 20 screening patients.
  5. Days 29-35 — formalize HSAT triage + AASM 2023 scoring + CPAP adherence automation; pull ResMed AirView / Philips DreamMapper dashboards; set 30/60/90-day review cadence.
  6. Days 36-42 — biologic prior-auth automation (CoverMyMeds/Myndshft/Glidian) with GINA 2024 + GOLD 2025 templates + step-therapy appeal library.
  7. Days 43-49 — ILD pathway — HRCT AI pattern pre-read (Imbio LDA, Coreline Soft AVIEW, Siemens AI-Rad Companion) + MDD conference cadence + antifibrotic eligibility memo template.
  8. Days 50-60 — owner monthly scorecard live (biologic-eligible patients on-therapy within 30 days as the one number); MIPS MVP submission prep; quarterly HIPAA + AI-vendor DPA review.

8 Mistakes Pulmonology Practices Make With AI

  1. Finalizing PFT/DLCO/CPET reports without pulmonologist sign-off — violates CPT professional-component documentation.
  2. Letting AI set a Lung-RADS category without radiologist review — ACR LCSR + CMS NCD 210.14 require physician read.
  3. Skipping CPT G0296 shared-decision-making visit before initial Medicare LDCT — claim denied.
  4. Auto-submitting biologic prior-auth without documenting step-therapy exposure — first-cycle denial rate 50%+.
  5. Using consumer-grade LLMs on PHI without a BAA — HIPAA violation + state AG exposure.
  6. Missing CMS 90-day 4-hr/70% CPAP adherence window — DME claim clawback + Medicare audit risk.
  7. Diagnosing ILD without multidisciplinary discussion (MDD) — 2022 ATS/ERS guideline standard of care.
  8. Gating Google reviews ("only 5-star please") — FTC Fake Reviews Rule 16 CFR 465, $51,744/violation.

Frequently Asked Questions

Can AI interpret PFT/spirometry/DLCO reports for a pulmonology clinic?

AI can produce a first-pass interpretation mapped to ATS/ERS 2022 standards (FEV1, FVC, FEV1/FVC, TLC, RV, DLCO, KCO, bronchodilator response, pattern classification — obstructive/restrictive/mixed/normal) — but a board-certified pulmonologist must sign the final report. FDA-cleared tools (MGC Diagnostics BreezeSuite AI, ndd Medical EasyOne AI, Vyaire SentrySuite, Morgan Scientific ComPAS) are decision-support only. Never let AI finalize a PFT without physician review — that violates CPT 94010/94060/94726/94727 professional-component documentation and state medical-board AI guidance.

How does AI fit into low-dose CT lung cancer screening (LDCT) under USPSTF 2021 criteria?

AI nodule-detection + Lung-RADS classification (Optellum Virtual Nodule Clinic, Riverain ClearRead CT, Aidoc, AIDOC Pulmonary, Imbio LDA, ClearRead) assists radiology overread but the treating pulmonologist/radiologist signs the final Lung-RADS 1-4X category + follow-up. USPSTF 2021: age 50-80, 20 pack-year smoking history, current smoker or quit within 15 years. CMS NCD 210.14 covers annual LDCT at the screening rate. Shared decision-making visit (CPT G0296) required for Medicare before initial LDCT. AI cannot replace that conversation.

Can AI handle OSA workflow from HSAT through CPAP adherence?

Yes, within guardrails. AI can triage STOP-BANG + Epworth intake, score home sleep apnea tests (HSAT — NightOwl, WatchPAT, ApneaLink, Alice NightOne, Nox T3) against AASM 2023 scoring rules, draft a CPAP/BiPAP/APAP prescription for physician signature, and auto-pull CPAP adherence data from ResMed AirView, Philips DreamMapper, Fisher & Paykel Sleep Style, and Lowenstein SleepDoc for CMS 90-day 4-hr/night 70% compliance. AI cannot diagnose OSA — AASM + state medical-board require physician interpretation. All DME CPAP claims need six-element LCD-compliant order signed by the ordering physician.

What compliance lines can AI never cross in a pulmonology practice?

AI cannot: finalize PFT/spirometry/DLCO/CPET reports, interpret chest CT/HRCT/LDCT without pulmonologist or radiologist sign-off, diagnose OSA or ILD, prescribe controlled-substance cough suppressants (codeine, hydrocodone — Schedule II/III — require DEA EPCS + state PDMP query CA CURES / TX PMP / FL E-FORCSE / NY I-STOP), certify home oxygen (CPT E0424/E0431/E0439 + Medicare Certificate of Medical Necessity CMN 484.03), approve biologic prior-auth (Dupixent, Tezspire, Fasenra, Nucala, Xolair) without physician medical-necessity review, handle PHI in consumer LLMs without BAA, or sign a disability/FMLA/DOT medical examiner form (49 CFR 391.43).

What ROI should a 2-5 pulmonologist practice expect from a full AI stack in year 1?

Benchmarks from CHEST + ATS 2025 + Journal of Clinical Sleep Medicine: ambient-scribe cuts documentation 50-65% (1.5-2.0 hr/day/MD reclaimed), AI PFT pre-read cuts interpretation turnaround 55-70%, LDCT nodule-detection AI lifts Lung-RADS concordance 12-18%, CPAP-adherence automation lifts 90-day compliance 20-30%, biologic prior-auth automation cuts denial rate 40-55% and first-fill TAT by 8-12 days, OSA HSAT triage lifts per-sleep-study revenue and cuts no-show rate. Net: a 3-MD practice typically sees $85-160k net margin lift year 1 after software + training + BAA review.

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