Neurology & Pain Management Coding Alert

Question: My sleep lab often performs oximetry monitoring. We charge for the facility fee with 94762, but we also want to charge for the interpretation fee as well. Can we bill for this and get paid?

Indiana Subscriber

Answer: No, you should not report 94762 (Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring [separate procedure]). Payers will not reimburse you for the oximetry because it is considered a requirement or component of the sleep study.

Physicians use oximetry (sometimes called "pulse oximetry" or "pulse ox") to monitor the oxygenation of hemoglobin in the bloodstream. According to the 2010 Medicare Physician Fee Schedule, Medicare, and payers that follow Medicare's fee schedule, consider 94762 a status T code. These "T" codes are bundled into many of the procedural codes and cover technical services only.

You should therefore code only for the other services performed by your neurologist.

Back up: Consider that the definition for 95806 includes an oximetry component: Sleep study, unattended, simultaneous recoding of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort [e.g., thoracoabdominal movement].

In addition, the Correct Coding Initiative (CCI) edits also bundle 94762 as a column 2 code with various sleep study codes. This edit carries a "0" modifier indicator, so you cannot bypass it under any circumstances.