How To Use CPT Code 94726

CPT 94726 is a code used for plethysmography to determine lung volumes and, when performed, airway resistance. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 94726 procedures.

1. What is CPT 94726?

CPT 94726 is a medical code used to describe a specific type of pulmonary function test called plethysmography. This test is performed to determine lung volumes, such as total lung capacity, residual volume, and functional residual capacity, and may also include checking airway resistance. The code is used by medical professionals to accurately document and bill for this procedure.

2. 94726 CPT code description

The official description of CPT code 94726 is: “Plethysmography for determination of lung volumes and, when performed, airway resistance.”

3. Procedure

The 94726 procedure involves the following steps:

1. The patient is seated in a specially designed small room, often called a body box, or has belts wrapped around their chest and abdomen to sense changes in volume and pressure.
2. A mouthpiece attached to a measuring device is used to measure volume and pressure changes as the patient breathes.
3. The patient may be asked to perform panting to check airway resistance.
4. The provider interpreting the results reviews the pressure volume curves created during testing as well as the pressure and flow results if the patient also completed the airway resistance test.
5. The provider checks for errors, interprets the results, and documents the interpretation in the medical record.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 94726 services are those experiencing symptoms affecting the lungs, such as shortness of breath, or those with conditions such as emphysema or lung cancer. The test may also be ordered for patients with other respiratory issues or as part of a preoperative evaluation for lung surgery.

5. When to use CPT code 94726

It is appropriate to bill the 94726 CPT code when a provider performs plethysmography to determine lung volumes and, when performed, airway resistance. This code should be used when the procedure is medically necessary and ordered by a qualified healthcare professional for the diagnosis or treatment of a patient’s respiratory condition.

6. Documentation requirements

To support a claim for CPT 94726, the following information should be documented:

• Medical necessity for the test, including the patient’s symptoms or diagnosis
• Order for the test from a qualified healthcare professional
• Details of the procedure, including the method used (body box or belts), and any additional tests performed (such as airway resistance)
• Results of the test, including pressure volume curves and any airway resistance measurements
• Interpretation of the results by the provider, including any relevant findings and their impact on the patient’s diagnosis or treatment plan

7. Billing guidelines

When billing for CPT code 94726, keep in mind the following guidelines:

• If reporting only the professional component for the service, append professional component modifier 26 to the code.
• If reporting only the technical component for the service, append technical component modifier TC to the code, unless the hospital provided the technical component. In that case, do not append modifier TC because the hospital’s portion is inherently technical.
• Do not append a professional or technical modifier to the code when reporting a global service in which one provider renders both the professional and technical components.
• Do not report 94726 in conjunction with 94727 or 94728.

8. Historical information

CPT 94726 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Similar codes to CPT 94726

Five similar codes to CPT 94726 and how they differentiate are:

• CPT 94727: This code is used for gas dilution or washout testing for lung volumes, which is a different method than plethysmography.
• CPT 94728: This code is for oscillometry, a test that measures airway resistance and reactance using sound waves, rather than plethysmography.
• CPT 94010: This code is for spirometry, a test that measures the amount and speed of air a patient can inhale and exhale, not lung volumes or airway resistance.
• CPT 94060: This code is for bronchospasm evaluation, which includes spirometry before and after bronchodilator administration, not plethysmography.
• CPT 94620: This code is for a simple pulmonary stress test, which measures the patient’s response to exercise or other stressors, not lung volumes or airway resistance.

10. Examples

Here are 10 detailed examples of CPT code 94726 procedures:

1. A patient with shortness of breath undergoes plethysmography to determine lung volumes and airway resistance, revealing reduced lung capacity and increased airway resistance.
2. A patient with a history of emphysema has a plethysmography test to monitor their lung volumes and airway resistance, showing a decline in lung function since their last test.
3. A patient with suspected lung cancer undergoes plethysmography to assess lung volumes and airway resistance before surgery, providing baseline data for postoperative comparison.
4. A patient with asthma has a plethysmography test to evaluate lung volumes and airway resistance, helping their provider adjust their treatment plan.
5. A patient with chronic obstructive pulmonary disease (COPD) undergoes plethysmography to determine lung volumes and airway resistance, aiding in the management of their condition.
6. A patient with a persistent cough has a plethysmography test to assess lung volumes and airway resistance, ruling out certain respiratory conditions.
7. A patient with a history of smoking undergoes plethysmography to evaluate lung volumes and airway resistance, providing information on their lung health and potential risk factors.
8. A patient with cystic fibrosis has a plethysmography test to monitor lung volumes and airway resistance, helping their provider track the progression of their disease.
9. A patient with interstitial lung disease undergoes plethysmography to assess lung volumes and airway resistance, providing data for their treatment plan.
10. A patient with a lung transplant has a plethysmography test to evaluate lung volumes and airway resistance, ensuring proper function of the transplanted lung.