How To Use CPT Code 94727

CPT 94727 describes the gas dilution or washout procedure used to determine lung volumes and, if necessary, the distribution of ventilation and closing volumes. 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 94727?

CPT 94727 is a code used to describe a pulmonary function test that assesses a patient’s lung volumes using gas dilution or washout techniques. This test compares a known concentration of an inhaled gas with the patient’s exhaled breath to determine lung volumes. It may also assess ventilation distribution and closing volumes if necessary.

2. Official Description

The official description of CPT code 94727 is: ‘Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes.’

3. Procedure

1. The provider sets up the testing instruments and prepares the patient for the pulmonary function test.
2. The patient breathes into a mouthpiece attached to a measuring device while following the provider’s instructions on breathing techniques.
3. In a gas dilution test, the patient inhales a known amount of a gas, typically helium, and the instruments measure the final exhaled concentration to calculate lung volumes.
4. In a washout test, the patient inhales a known amount of nitrogen and then breathes only oxygen to wash out the nitrogen from the lungs. The instruments measure the volume of air exhaled and the concentration of nitrogen present to determine lung volumes.
5. The provider may also assess ventilation distribution and closing volumes by analyzing the curves measured during the test.
6. The provider interprets the test results and documents the findings in the patient’s medical record.

4. Qualifying circumstances

CPT 94727 is typically ordered for patients with symptoms affecting the lungs, such as shortness of breath, or for those with conditions like emphysema or lung cancer. The test is performed by a provider who is trained and qualified to administer and interpret pulmonary function tests. Gas dilution or washout techniques are used to determine lung volumes and, if necessary, assess ventilation distribution and closing volumes.

5. When to use CPT code 94727

CPT code 94727 should be used when a provider performs a gas dilution or washout procedure to determine lung volumes and, if necessary, assess ventilation distribution and closing volumes. It is appropriate to use this code when the test is ordered for patients with symptoms affecting the lungs or specific lung conditions. However, it should not be reported in conjunction with CPT code 94726.

6. Documentation requirements

To support a claim for CPT code 94727, the provider must document the following information:

• Patient’s symptoms or lung condition warranting the test
• Details of the gas dilution or washout technique used
• Date and time of the test
• Test results, including lung volumes and any assessment of ventilation distribution and closing volumes
• Interpretation of the test findings by the provider

7. Billing guidelines

When billing for CPT code 94727, ensure that the test is performed by a qualified provider and that the gas dilution or washout technique is used to determine lung volumes. It is important to follow the specific guidelines for reporting the professional and technical components of the service, including the use of modifiers if necessary. Do not report CPT code 94727 in conjunction with CPT code 94726.

8. Historical information

CPT code 94727 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

1. A patient with shortness of breath undergoes a gas dilution test to determine their lung volumes and assess ventilation distribution.
2. A patient with emphysema undergoes a washout test to measure their lung volumes and closing volumes.
3. A patient with lung cancer undergoes a gas dilution test to assess their lung volumes and ventilation distribution.
4. A patient with asthma undergoes a gas dilution test to determine their lung volumes and assess closing volumes.
5. A patient with chronic obstructive pulmonary disease (COPD) undergoes a washout test to measure their lung volumes and assess ventilation distribution.
6. A patient with suspected airway hyperresponsiveness undergoes a bronchial provocation test instead of a gas dilution or washout test.
7. A patient with suspected bronchospasm undergoes a bronchospasm evaluation instead of a gas dilution or washout test.
8. A patient with no lung symptoms or conditions does not require a gas dilution or washout test.
9. A patient with a history of lung disease undergoes a gas dilution test to determine their lung volumes and assess ventilation distribution.
10. A patient with a lung infection undergoes a washout test to measure their lung volumes and closing volumes.