Cardiology Coding Alert

Question: Can I code for oximetry with an office visit?


New York Subscriber

Answer: Most cardiologists should not report pulse oximetry separately because a cardiologist, in most cases, is assessing pulse oximetry during an E/M service.

Don't be fooled: You'll find three codes available to report pulse oximetry in your CPT manual:

• 94760--Noninvasive ear or pulse oximetry for oxygen saturation; single determination

• 94761--... multiple determinations (e.g., during exercise)

• 94762--... by continuous overnight monitoring (separate procedure).

Several Medicare carriers (such as Palmetto GBA, National Heritage Insurance Company, Cigna, Group Health Inc., Empire Medicare Services, and Noridian Administrative Services) have clear coverage guidelines for pulse oximetry services.  Each reflects that a physician can only perform these services if medically necessary.

You should not separately report routine measurement of pulse oximetry. For example, if your cardiologist routinely measures pulse oximetry as another vital sign during an office visit, you should not report a pulse oximetry code.

Recommended: You may want to read what Medicare carrier Health Now's local coverage determination says about pulse oximetry. This policy states: "CPT codes 94760 and 94761 have been designated status 'T' retroactive to Jan. 1, 2000." A "T" status means you cannot report these codes with another code for the same encounter.

Addendum B of the Federal Register, which lists the Physician Fee Schedule, contains the status indicator of each code. Most commercial carriers follow this Medicare rule, but always check with your carrier.

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.