ED Coding and Reimbursement Alert

Question: I frequently get asked about coding 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; singe determination). If you do recommend coding for it, what documentation should I look for in the record?

Alabama Subscriber

Answer: Because the code is for the interpretation of the pulse ox, you should only bill for it when the physician has stated the value of the pulse ox and whether it was hypoxic or normal. You should also restrict your use of this to code to billing for patients who present with diagnoses that support performing the pulse ox such as asthma or chest pain. And don't forget modifier -26 (Professional component) to show you are not billing for the technical portion of the test.

Medicare includes 94760 in the E/M, so you cannot bill government carriers. Not everyone thinks that interpreting a pulse oximetry value is a discrete professional service; however, the facility should report it because it's a discrete nursing service requiring equipment and time. This is consistent with CMS direction to report the service with a facility charge even though Medicare will bundle payment with the visit level. Pulse oximetry is a required service to support observation care for respiratory distress patients and must be reported on the hospital bill with a charge.