Pulmonology Coding Alert

Despite Medicares recent decision to end separate pulse oximetry reimbursement, it is possible to get paid separately by using the correct ICD-9 codes and documenting in detail other services that may have been provided during the visit.

Background on Pulse Oximetry

Medicare and some private carriers had been bundling pulse oximetry (94760-94762) with evaluation and management services (99201-99215) in a confusing patchwork of reimbursement decisions that often left billers in the dark.

But Medicares recent decision to end pulse oximetry reimbursements Jan. 1, 2000, means commercial carriers will need to set their own courses of action. Under Medicares action, pulmonologists will no longer be able to bill separately for pulse oximetry using 94760 (noninvasive ear or pulse oximetry for oxygen saturation; single determination) or 94761 (multiple determinations, e.g., during exercise).

The codes were dismissed by the Health Care Financing Administration (HCFA), which last summer proposed rules declaring that along with taking a patients temperature and blood pressure, these pulse oximetry codes represented simple diagnostic procedures ... the technical work involved in these procedures is small, while the physician work involved in interpreting them is included in an evaluation and management service [visit] or a more complex procedure.

HCFA proposed giving the procedures the payment status B for payment always bundled into payment for other services. The proposal also bundled 94762 (pulse oximetry by continuous overnight monitoring).

Pulmonologists protested the proposed changes, prompting HCFA to make an adjustment in its plans. Pulse oximetry is not a routine diagnostic service like taking a patients blood pressure and family physicians or general practitioners commonly dont have the equipment in their offices, explains Sam Birnbaum, CMPE, executive director of Pulmonary Rehabilitation Associates of Youngstown, Ohio, and chair of the American College of Chest Physicians Practice Administration Section. These instruments are much more expensive to purchase and maintain than a thermometer or a sphygmometer. To suggest that the measurement of pulse oximetry is as routine and common as a blood pressure or a temperature is to suggest that all physicians should be required to include pulse oximetry for all patient visits.

In order for a COPD patient to qualify for supplemental home oxygen therapy, Medicare requires documentation of their oxygen saturation levels by either arterial blood gas studies or pulse oximetry, he says. Many times patients go home from the hospital with supplemental oxygen. We follow up with them in the office. If the pulse oximetry shows that theyve improved enough to discontinue the supplemental oxygen, weve saved Medicare a considerable amount of money.

HCFA agreed in its final rules, published in November, to let physicians continue to bill separately for the continuous overnight monitoring. The agency said that while the procedure [...]