Inpatient Facility Coding & Compliance Alert

Question: A patient is on a ventilator in the hospital ICU. Can the provider bill 94762 on a daily basis?

Minnesota subscriber

Answer: Hospitals should ideally not be using CPT® codes alone for billing purposes. However, if the provider is submitting the claim for reimbursement of professional services which are medically necessary, daily billing may be appropriate (such as with 94762, Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring [separate procedure]). Whether the billing is appropriate basically depends on the payer specific policies. Generally speaking, the code is a separate procedure which means that it is coded and billed only when not provided in connection with another related service.  For the Medicare program, the MPFS (Medicare Physician Fee Schedule) status indicator is ‘A’ so that 94762 can be paid separately under the proper circumstances.  See also the NCCI (National Correct Coding Initiative) edits for CPT® 94762.