Cardiology Coding Alert
Don't Hold Your Breath for Pulse Oximetry Pay
Question: Will insurers reimburse us for pulse oximetry if we perform it with other procedures? New York Subscriber Answer: CPT lists two pulse oximetry measurement codes: 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination) and 94761 (... multiple determinations). But most insurers won't reimburse these services if you perform them with other procedures. Therefore, your physicians may have to write off services that would otherwise generate between $1.56 and $3.74 (the current Medicare range for 94760). HealthNow, upstate New York's Medicare carrier, addresses this concept in a local medical review policy (LMRP), which states, "CPT codes 94760 and 94761 have been designated status T retroactive to Jan. 1, 2000. There are RVUs and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider." If any other services are billed on the same date, they will be bundled. Another Medicare carrier, Regence Blue Cross and Blue Shield of Utah, similarly states in its LMRP, "The only time these services are separately payable is when they are medically necessary and there are no other services payable under the physician fee schedule billed on the same date by the same supplier." And, Regence indicates that "procedure codes 94760 and 94761 are considered to be 'incident-to' physician's service; therefore, like other vital-sign measurements, this service is included in the payment for the physician service." Even so, if your practice continues to document pulse oximetry, you may be able to use this documentation to increase your E/M service level. You can include your physician's review and/or order of tests from CPT's medicine section. Although pulse oximetry is not separately billable, the procedure does count when calculating your supported complexity level, which can help you select an appropriate E/M code (99201-99215).
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