ED Coding and Reimbursement Alert

Payment for pulse oximetry varies widely from payer to payer, so pay close attention to policy differences in order to avoid denials and collect separate payment when it's covered. Make sure each of your payer policies allows billing separately for the professional interpretation of pulse oximetry, a service that measures the concentration of oxygen in the blood. Three codes describe the service:

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

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

CPT 94762 ... by continuous overnight monitoring (separate procedure). If you bill for the interpretation of pulse oximetry and your hospital owns the equipment, append the pulse oximetry code with modifier -26 (Professional component). Separate Pulse Oximetry Can Get Paid For some payers, pulse oximetry can be a separately identifiable service, so don't automatically bundle it into other service codes.

You can separately bill pulse oximetry when it's done for the purposes of making a diagnosis or assisting with medical decision-making in relationship to the chief complaint, says Jan Loomis, director of coding and documentation at TeamHealth West in Pleasanton, Calif. A patient with asthma is a good example of this, she says. On the other hand, oximetry for a patient with a sprained ankle would likely be considered a routine vital and should not be billed, she adds. For most payers, to bill pulse oximetry separately, the test must go beyond routine testing and the recording of a numerical result. It is the physician's interpretation of the numerical result that contributes to the patient's care plans, says Mike Ganovsky, MD, CPC, CFO, of Greater Washington Emergency in suburban Maryland. Though you're allowed to bill for this interpretation, it is still prudent to "tread lightly" when it comes to reporting pulse oximetry as a separate service, says Robert La Fleur, MD, FACEP, president of Medical Management Specialists. "In this day and age, pulse oximetries are done almost like a vital sign," he says. Consider whether the physician's interpretation of pulse oximetry warrants a separate charge any more than his interpretations of pulse, blood pressure, and temperature do, La Fleur says. Some payers may pay separately for pulse oximetry interpretation, but just because you can bill for it doesn't mean you should, he adds. Documentation From the Physician Is Required Lean documentation for pulse oximetry is a surefire way not to get paid. When medical necessity justifies separate payment, it must be clearly documented in order for the service to be coded, says Maria Narvaez, RHIT, a coding consultant in Pennsylvania for National Health Systems. Most insurers require a note by the physician, adds Todd Thomas, CPC, CCS-P, president of Thomas & Associates, a company ensuring reimbursement for [...]