How To Use CPT Code 94200

CPT 94200 describes the measurement of maximum breathing capacity, also known as maximal voluntary ventilation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 94200?

CPT 94200 can be used to measure the largest volume of air that a patient can voluntarily breathe while breathing as deeply and quickly as possible for a specified period of time. This test helps determine obstructive and restrictive lung diseases or assesses the condition and strength of the patient’s lungs prior to surgery.

2. Official Description

The official description of CPT code 94200 is: ‘Maximum breathing capacity, maximal voluntary ventilation.’

3. Procedure

1. The provider instructs the patient to breathe in as far as possible and out as far as possible, as quickly as possible for twelve to fifteen seconds.
2. A nose clip is placed on the patient, and the patient places the mouthpiece of a spirometer in their mouth.
3. The patient starts breathing normally, and the provider measures the maximum voluntary ventilation by instructing the patient to breathe in and out as rapidly but as fully as possible, for no longer than five breaths.
4. The provider repeats the process as needed, extrapolating the data to a liter per second or liter per minute expression.
5. The provider reviews and evaluates the graphic representation of the data.

4. Qualifying circumstances

CPT 94200 can be used to assess the condition and strength of the patient’s lungs prior to surgery or to determine obstructive and restrictive lung diseases. It is typically performed by a healthcare professional who specializes in pulmonary diagnostic testing and therapies.

5. When to use CPT code 94200

CPT code 94200 should be used when measuring the maximum breathing capacity or maximal voluntary ventilation of a patient. It is important to note that CPT code 94200 should not be reported in conjunction with CPT codes 94010 or 94060.

6. Documentation requirements

To support a claim for CPT 94200, the healthcare professional must document the following information:

• Patient’s diagnosis or reason for the test
• Date and time of the test
• Specific instructions given to the patient
• Results of the test, including the maximum breathing capacity or maximal voluntary ventilation
• Any additional relevant information or observations

7. Billing guidelines

When billing for CPT 94200, ensure that the test is performed by a qualified healthcare professional who specializes in pulmonary diagnostic testing and therapies. It is important to note that CPT code 94200 should not be reported in conjunction with CPT codes 94010 or 94060. If reporting only the professional component, append modifier 26 to the code. If reporting only the technical component, append modifier TC to the code. Do not append a professional or technical modifier when reporting a global service in which one provider renders both components.

8. Historical information

CPT 94200 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes CPT 94200 to assess their lung function prior to a scheduled surgery.
2. A healthcare professional performs CPT 94200 to evaluate a patient with suspected obstructive lung disease.
3. CPT 94200 is used to measure the maximal voluntary ventilation of a patient with a history of restrictive lung disease.
4. A provider orders CPT 94200 to assess the lung capacity of a patient with chronic respiratory symptoms.
5. A healthcare professional performs CPT 94200 to monitor the progress of a patient undergoing pulmonary rehabilitation.
6. CPT 94200 is used to evaluate the lung function of a patient with a history of smoking.
7. A provider orders CPT 94200 to assess the lung capacity of a patient with a suspected pulmonary disorder.
8. A healthcare professional performs CPT 94200 to evaluate the lung function of a patient with a history of occupational exposure to respiratory irritants.
9. CPT 94200 is used to measure the maximal voluntary ventilation of a patient with a known respiratory muscle weakness.
10. A provider orders CPT 94200 to assess the lung capacity of a patient with unexplained shortness of breath.