Respiratory Question for the Week of April 1, 2024


How does the presence of unit of service edits and medically unlikely edits impact the billing practices for code 94375, particularly regarding the flow volume loop as an alternate method of calculating standard spirometric parameters, and what considerations should healthcare providers keep in mind to ensure proper reimbursement while adhering to CMS guidelines?


The flow volume loop is considered an alternate method of calculating a standard spirometric parameter. Alternate methods of reporting identical or duplicative data should not be billed separately on the same date of service. Unit of service edits do exist for 94375, when multiple determinations are performed on the same date of service to complete a pulmonary assessment, only one unit of service is appropriate. CMS has published a medically unlikely edit (MUE) of 1 for CPT code 94375, with an MUE adjudication indicator (MAI) of 3, indicating that it would be clinically inappropriate to bill for more than one episode of care (or encounter) per date of service.

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