Beat Double Billing Denials by Knowing What’s Included in Stress Tests
Question: We received a claim denial, but I’m not sure why. The patient came in for an exercise stress test, and the pulmonologist measured the patient’s heart rate, oxygen titration, and evaluated the patient’s pulse oximetry several times during the test. We initially reported 94618 and 94761. How can we correct this claim? New Hampshire Subscriber Answer: You can correct this claim by reporting only one CPT® code instead of two. Use 94618 (Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed) to report the stress test. Upon review of the descriptor, you’ll notice that the oximetry (ear or pulse) is included in the stress testing. This means that you won’t separately report 94761 (Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise)) on your claim. The National Correct Coding Initiative (NCCI) edits list 94761 as a column 2 code for 94618 with a modifier indicator of “0.” The “0” indicates that Medicare does not allow you to override the edit pair and unbundle the procedures to bill for each one separately. In your case, the claim looks like the provider is attempting to double bill for the pulse oximetry component. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
