ED Coding and Reimbursement Alert

Question: Is it appropriate to bill pulse oximetry (94760-94761) in addition to the evaluation and management (E/M) service? The patient has a monitor attached to the finger and the level is displayed on the monitor.

Anonymous subscriber

Answer: In most cases, the physician is not placing the pulse ox monitor on the patient, but is only interpreting the results of the testing, says Betty Ann Price, BSN, RN, CCS-P, president, Professional Reimbursement and Coding Strategies, Inc., in Palmetto, FL. And, in most cases, the hospital owns the monitor, not the physician.

Price recommends that, if the physician wants to bill for pulse oximetry, then he or she should bill the 94760 with a -26 modifier (professional component) to indicate that the service provided by the physician was only the interpretation of the oxygen saturation percentage. Physician documentation should support that an interpretation of the oxygen (O2) saturation occurredthis means not only recording the saturation levels but how those levels related to the care of the patient.

Note: Many payers, however, consider pulse oximetry monitoring to be included in the E/M code and will not pay separately for the pulse oximetry code, even when the modifier is applied.