ED Coding and Reimbursement Alert

Question: Is it appropriate for emergency physicians to bill for pulse oximetry? If so, may they do so even if they dont own the equipment?

North Dakota Subscriber  
Answer: Yes, you may assign a pulse oximetry code to describe the services provided in the ED. These services are described in 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination), 94761 ( multiple determinations [e.g., during exercise]), and 94762 ( by continuous overnight monitoring [separate procedure]). These codes may be reported whether or not the physician owns the equipment. If the emergency physician doesnt own the equipment and simply interprets the test results, modifier -26 (Professional component) would be appended.
 
Payment for pulse oximetry varies widely from payer to payer. CPT notes that these codes may be assigned in addition to an E/M service (e.g., 99283, Emergency department visit) when a separate service is provided.

In the 2002 Physician Fee Schedule, available on the CMS Web site at www.cms.gov, Medicare has assigned a T status to 94760 and 94761. The T designation means that the service is considered an injection. While there are practice expense and malpractice relative value units (RVUs) and payment amounts assigned for these services (although no physician work RVUs), they are paid only if there are no other services payable under the Physician Fee Schedule billed on the same date by the same provider. If the same provider bills any other services payable under the Physician Fee Schedule on the same date, these services are bundled into the physician services for which payment is made. Therefore, pulse oximetry is considered bundled into any E/M service rendered to Medicare beneficiaries by the same physician on the same day. To explain its thinking, CMS notes in the 2000 Medicare Physician Fee Schedule, published in the Federal Register, Nov. 2, 1999, (page 59413), that it considers interpretation of pulse oximetry to be no more than taking a temperature and that it is not separately billable.