# Pulse oximetry in ER 94760-94761



## Mindy Davis (Feb 11, 2016)

I'm doing a little research to see if this is something we can bill for in the ER. I know Medicare & Medicaid will not pay for this service they consider it to be bundled with the E&M. I'm not sure on our commercial payers though.


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## CodingKing (Feb 11, 2016)

You shouldn't be billing it to commercial insurances. its like trying to charge for taking a persons blood pressure, pulse, temperature, height and weight. Its all bundled in the E&M


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## Mindy Davis (Feb 11, 2016)

CodingKing said:


> You shouldn't be billing it to commercial insurances. its like trying to charge for taking a persons blood pressure, pulse, temperature, height and weight. Its all bundled in the E&M



thank you for your reply. I understand what the code means. My practice manager has been told that its a billable charge in the ED. I'm asking if anyone does bill this and if so how do they bill it.


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## svatek.laura@gmail.com (Feb 15, 2016)

*billable*

It is billable if it is a reading apart from the vitals. The biggest instance is when it needs to be determined whether or not to perform a breathing treatment. When a patient is experiencing trouble breathing or chest pain - these are good indicators that a pulse ox would be done to determine course of treatment. 

When patients have pulse ox reading done as part of vitals - this is not separately billable.


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## jimbo1231 (Feb 17, 2016)

*Pulse Ox*

Pulse Ox codes were one of those "payer specific" codes(like evening/weekend services) that ED coding/billing entities would code to payers who would reimburse for them. Since very few pay and the medical necessity is debatable, coding is rare these days. But there are still some instances for reasons cited above.  Jim


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## Mindy Davis (Feb 17, 2016)

svatek.laura@gmail.com said:


> It is billable if it is a reading apart from the vitals. The biggest instance is when it needs to be determined whether or not to perform a breathing treatment. When a patient is experiencing trouble breathing or chest pain - these are good indicators that a pulse ox would be done to determine course of treatment.
> 
> When patients have pulse ox reading done as part of vitals - this is not separately billable.



thank you for your reply. In that instance would a modifier 25 be needed on the E&M?


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