Pediatric Coding Alert

Question: We are beginning to offer oxygen saturations and pulse readings in the office. How should we code for this?

Maryland Subscriber

Answer: You'll report pulse oximetry with 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination). File the claim as appropriate, but know that some insurance companies don't reimburse because they follow the CMS determination that E/M work includes pulse oximetry.

Insurance companies that do reimburse don't pay much. For example, the national average non-facility payment according to the Medicare Physician Fee Schedule is $2.53. Regardless of payment, always include 94760 on your claim when applicable because it supports a higher level of medical decision making.

Multiple option: If you test pulse oximetry multiple times, such as before and after an aerosol treatment, code with 94761 (... multiple determinations [e.g., during exercise) instead.