How To Use CPT Code 94375

CPT 94375 describes the procedure for a respiratory flow volume loop study, which is used to differentiate between obstructive and restrictive pulmonary disorders. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 94375?

CPT 94375 can be used to describe a respiratory flow volume loop study, which is performed to differentiate between obstructive and restrictive pulmonary disorders. This procedure involves graphing the rate of airflow as a function of lung volume during a complete respiratory cycle, consisting of forced inspiration followed by forced expiration. The resulting plotted curve, known as a flow volume loop, is analyzed to assess pulmonary function.

2. Official Description

The official description of CPT code 94375 is: ‘Respiratory flow volume loop; professional component’.

3. Procedure

1. The healthcare provider administers a respiratory flow volume loop study to assess pulmonary function.
2. The patient is instructed to perform a complete respiratory cycle, including forced inspiration and forced expiration.
3. The healthcare provider graphs the rate of airflow as a function of lung volume to create a flow volume loop.
4. The resulting flow volume loop is analyzed to differentiate between obstructive and restrictive pulmonary disorders.
5. The severity of the patient’s condition and their response to therapy can also be assessed using the flow volume loop.

4. Qualifying circumstances

CPT 94375 is used when a respiratory flow volume loop study is performed to differentiate between obstructive and restrictive pulmonary disorders. Obstructive pulmonary disorders make it difficult for a patient to breathe, such as chronic obstructive pulmonary disease or apnea. Restrictive pulmonary disorders, on the other hand, restrict air flow and oxygenation due to incomplete lung expansion, as seen in conditions like asthma or cystic fibrosis.

5. When to use CPT code 94375

CPT code 94375 should be used when a respiratory flow volume loop study is performed without the administration of bronchodilators. This code includes the necessary spirometry to complete the service. It is important to note that most payers will not reimburse for CPT 94375 when reported with CPT code 94010, as the flow volume loop is considered a component of spirometry. Therefore, it is essential to check with the insurance company for local guidelines and billing requirements.

6. Documentation requirements

To support a claim for CPT 94375, the healthcare provider must document the following information:

• Reason for performing the respiratory flow volume loop study
• Date and time of the procedure
• Results of the flow volume loop analysis
• Any additional relevant findings or observations
• Signature of the healthcare provider performing the service

7. Billing guidelines

When billing for CPT 94375, ensure that the procedure is performed by a qualified healthcare provider. It is important to consider the location of the testing, as pulmonary function tests have both a professional and a technical component. Modifier 26 should be used when reporting the professional component, while the facility should report the technical component with modifier TC. It is also crucial to follow the guidelines regarding reporting CPT 94375 with other codes, as mentioned earlier.

8. Historical information

CPT 94375 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 with chronic obstructive pulmonary disease undergoes a respiratory flow volume loop study to assess the severity of their condition and monitor their response to therapy.
2. A healthcare provider performs a flow volume loop study on a patient with asthma to differentiate between obstructive and restrictive pulmonary disorders.
3. A respiratory therapist administers a respiratory flow volume loop study to a patient with cystic fibrosis to assess their lung function and guide treatment decisions.
4. A patient with suspected sleep apnea undergoes a flow volume loop study to evaluate their respiratory function during sleep.
5. A healthcare provider performs a respiratory flow volume loop study on a patient with suspected restrictive pulmonary disorder to confirm the diagnosis and determine the appropriate treatment approach.
6. A patient with chronic bronchitis undergoes a flow volume loop study to assess their lung function and monitor the effectiveness of bronchodilator therapy.
7. A healthcare provider performs a respiratory flow volume loop study on a patient with suspected pulmonary fibrosis to evaluate their lung function and guide treatment decisions.
8. A patient with suspected chronic obstructive pulmonary disease undergoes a flow volume loop study to differentiate between obstructive and restrictive pulmonary disorders and determine the appropriate treatment approach.
9. A healthcare provider performs a respiratory flow volume loop study on a patient with suspected bronchiectasis to assess their lung function and guide treatment decisions.
10. A patient with suspected interstitial lung disease undergoes a flow volume loop study to evaluate their lung function and determine the appropriate treatment approach.