Pediatric Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How should we bill pulse oximetry?

Arizona Subscriber

Answer: The code for pulse oximetry is CPT 94760 (noninvasive ear or pulse oximetry for oxygen saturation; single determination). The answer to whether you can bill for pulse oximetry separately depends in part on the payer. Many Medicaid carriers consider pulse oximetry to be a part of the care rendered to the patient, and not separately billable.  
 
Some commercial payers do not bundle this service with E/M codes, so you can bill for it separately. In fact, CPT specifically states that the pulmonary procedure and interpretation codes 94010-94799 should be reported in addition to the appropriate E/M service code, "if a separate identifiable evaluation and management service is performed." Pulse oximetry is significant enough to be billed separately, and denials should be appealed.