Primary Care Coding Alert

Question: Why are claims for pulse oximetry nearly always denied?

Iowa Subscriber

 
Answer: Payment for pulse oximetry has been a source of confusion and frustration for family practices for a couple of years. Traditionally, 94760 (noninvasive ear or pulse oximetry for oxygen saturation; single determination) and 94761 (... multiple determinations [e.g., during exercise]) were not bundled into E/M codes reported the same day. But as part of the 2000 Medicare Fee Schedule, Medicare announced that it would no longer separately pay for these codes.
 
94760 and 94761 have been classified as status T on the Medicare relative value unit database. Although this designation is typically associated with injection codes, in this case it indicates that payment is included in the allowance for any physician services provided on the same day. Pulse oximetry is reimbursable only when it is the sole service provided to the patient on that date.
 
The good news is that many commercial payers will reimburse pulse oximetry even when it is performed on the same date as other services. Coders should ask their private insurers for their policies.

 -- You Be the Coder and Reader Questions were reviewed by Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City; and Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians.