ED Coding and Reimbursement Alert

Question: Is it acceptable for emergency physicians to bill for pulse oximetry interpretations even if they do not own the equipment?

Anonymous Georgia Subscriber

Answer: According to CPT, billing for pulse oximetry (94760-94762) is appropriate for emergency physicians even though they dont own the equipment. The documentation should show whether the reading was normal or abnormal and any corresponding treatment. The physician should report the code with the -26 modifier (professional component only) to indicate that this service is separate from the technical component. Emergency physicians should note that reimbursement for pulse oximetry determinations varies by payer. The American Medical Associations CPT Assistant advises a separate evaluation and management (E/M) code may be billed when a separate E/M service is performed. But the interpretation component of the codes cannot be counted again in the medical decision-making component of the E/M when the services are performed by the same physician.

Medicare has designated 94760 and 94761 as technical component only, which means that they do not recognize a separate interpretation component. Carriers that use Medicare RBRVS would consider the interpretation bundled with the E/M. So some payers will recognize physician services in pulse oximetry readings, some (like Medicare) will bundle this service in the E/M. But some may pay for a pulse oximetry determination and a separate E/M service.


Update:

In a carrier memorandum dated Jan. 5, 2000, titled Emergency Changes to the 2000 Medicare Physician Fee Schedule Database, the Health Care Financing Administration announced that it has changed its policy regarding 94760 and 94761. These codes are no longer bundled with the related E/M service and can be reported separately to Medicare. Carriers will be sent a new claims editing file with the corrected coding edits. The corrections to the previously published Medicare Fee Schedule are supposed to be effective for claims dated Jan. 1, 2000, and later and the editing corrections should have been implemented by Jan. 10, 2000. If your claims are denied by Medicare carriers, call your carrier representative and cite the above memorandum.