Primary Care Coding Alert

Question: A patient with chronic obstructive pulmonary disease (COPD), who also suffers from acute bronchitis, had been waking up in the morning feeling dizzy, disoriented, and experiencing a higher heart rate. The provider measured the patient’s O2 saturation in the office, and the results appeared normal. The provider then ordered continuous pulse oximetry monitoring overnight while the patient sleeps. Follow-up was requested for 3 days out. Can I report the at-home test separately from the in-office test?

Louisiana Subscriber

Answer: The first thing to note is that the National Correct Coding Initiative (NCCI) has edits involving the oximetry codes and office/outpatient evaluation and management (E/M) service codes. The NCCI edits have the oximetry codes as primary and the E/M codes as secondary, so if you bill an oximetry code and an office/outpatient E/M service for the same patient on the same date without any modifiers, you’ll only be paid for the oximetry, if the payer is following the NCCI edits. However, NCCI allows a modifier to override the edits, so where appropriate, append modifier 25 (Significant, separately identifiable evaluation and management service…) to the E/M to get paid for both services.

There are three oximetry codes:

• 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination)
• 94761 (… multiple determinations (eg, during exercise))
• 94762 (… by continuous overnight monitoring (separate procedure))

You’ll assign 94760 or 94761 for measurements captured during an in-person evaluation and management (E/M) visit, whereas 94762 is designated for continuous oximetry monitoring during an overnight session.

For your scenario, the provider ordered continuous overnight pulse oximetry monitoring due to the patient’s co-existing condition, making it a separate service. You can therefore report 94762 separately because CPT^® 94762 is considered a separate procedure. It is usually part of a more complex service, but if the procedure is done alone or with another unrelated procedure/service, it can be billed separately.