Pulmonology AI scribe 2026: PFTs, CPAP compliance, ILD documentation, and the bronchoscopy note

May 8, 2026 · 6 min read

Pulmonology generates four distinct documentation patterns that don't share a common template: office E/M with PFT trend interpretation, sleep medicine with CPAP compliance, interstitial lung disease (ILD) progression tracking, and bronchoscopy procedure notes. General AI scribes built around primary-care SOAP miss the trend-data and procedural specifics that pulmonary practice depends on.

The 2026 pulmonology-aware AI scribe stack handles four things: PFT trend integration, CPAP / BiPAP compliance documentation that supports payer authorization, ILD progression tracking with HRCT cross-reference, and bronchoscopy structured notes for billing.

PFT trend documentation

Pulmonary function tests (FEV1, FVC, FEV1/FVC, DLCO, TLC, RV, MIP/MEP) are typically reviewed at every chronic disease visit. The AI scribe should:

• Pull last 3-5 PFT studies via EHR or pulmonary lab API
• Surface the trend: FEV1 change in percent predicted, GOLD stage shift, response to treatment
• Tie today's medication or oxygen decision to the trend
• Document inhaler technique discussion (CMS quality measure for COPD)

CPAP / BiPAP compliance for sleep medicine

Medicare requires documented CPAP compliance for ongoing coverage:

• 4+ hours per night for at least 70% of nights in any 30-day period during the first 90 days
• Re-evaluation visit between days 31 and 91 documenting symptom improvement
• Continued documentation of compliance for ongoing coverage

The pulmonary AI scribe should pull CPAP compliance data (ResMed AirView, Philips Care Orchestrator, etc.) and structure the compliance note for payer review.

The pulmonology-aware system prompt

You are documenting a pulmonology encounter.

INPUT:
- Encounter audio transcript
- Patient: age, sex, smoking status, primary pulmonary dx
- Last 12 months PFT data (FEV1, FVC, DLCO etc.)
- Last 12 months HRCT or chest imaging if relevant
- CPAP compliance data if applicable
- Current pulmonary medication list

OUTPUT structured note:
1. Visit type: office E/M / sleep medicine f/u / ILD progression / pre-procedure / post-bronch
2. Subjective: dyspnea (modified MRC scale), cough, sputum, night symptoms, exercise tolerance
3. Objective: SpO2 room air + ambulatory, vital signs, exam (breath sounds, accessory muscle use, edema)
4. Trend data: PFT 4-value series; HRCT findings vs prior; CPAP compliance % if applicable
5. Assessment by problem with ICD-10 v28 specificity:
   - COPD: J44.x with severity (GOLD stage)
   - Asthma: J45.x with control level
   - ILD: J84.x with type
   - OSA: G47.33 with severity (AHI)
   - Pulmonary HTN: I27.x with classification
6. Plan:
   - Inhaler technique discussion (cite transcript — CMS COPD quality measure)
   - Oxygen titration if applicable
   - CPAP / BiPAP adjustment with compliance documentation
   - Pulmonary rehab referral with rationale
   - Vaccination status (flu, pneumococcal, COVID, RSV)
7. Patient instructions
8. Follow-up timing tied to clinical trajectory

Cite transcript or trend data for each clinical decision. For sleep medicine, structure CPAP documentation per Medicare authorization standards.

The bronchoscopy procedure note

You are documenting a bronchoscopy procedure.

OUTPUT structured procedure note:
1. Pre-op diagnosis + indication
2. Procedure: flexible bronch, EBUS, navigational, etc. (with CPT code)
3. Anesthesia: moderate sedation / monitored / general
4. Findings: airway anatomy by lobe, mucosa, secretions, masses, lesions
5. Interventions: BAL (location, volume), bronchial wash, biopsy (forceps, brush, transbronchial), EBUS-TBNA stations sampled
6. Specimens sent: cytology, microbiology, pathology
7. Complications: bleeding, hypoxia, pneumothorax, sedation events
8. Post-procedure: oxygenation, observation period, discharge readiness

Vendor and DIY paths

For solo or small pulmonary practices, the DIY stack with PFT trend integration and CPAP compliance pull dominates on price ($60-150/provider/month) and prior auth defensibility. For larger groups embedded in IDN, vendor enterprise integration handles the EHR write-back at scale.

BAA chain for pulmonology

Practice + EHR + PFT lab vendor + CPAP device vendor (ResMed AirView, etc.) + transcription vendor + LLM vendor. 5-6 BAA documents.

When to start

If your pulmonary practice has a sleep medicine component, the CPAP compliance documentation alone justifies the AI scribe stack — payer denials for incomplete compliance documentation are a recurring revenue leak. The DIY stack with structured CPAP documentation pays back the LLM cost in the first month.