Pulmonology Coding Alert

Question: Can I bill 94762 when a patient does this at home? Our office owns the equipment. Should the place of service be home and do I need to add modifier?


Florida Subscriber

Answer: Because you own the equipment that the patient is using, you can bill for the overnight oximetry. You should use 94762 (Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring [separate procedure]). You don't have to attach a modifier.

This code describes noninvasive ear or pulse oximetry for O2 saturation by continuous overnight monitoring. It is a "technical" code in that it does not involve any physician-work RVUs.

Before you bill 94762 for overnight desaturation oximetry, you have to meet Medicare's reporting guidelines. Generally, pulmonologists may provide continuous overnight monitoring of noninvasive ear or pulse oximetry in the home at another physician's request. In both locations, Medicare requires that the physician who provides the oximetry perform face-to-face interaction with the patient prior to initiating the procedure. This direct encounter allows the physician to assess the patient's comprehension and physical ability to carry out the instructions and also allows the patient to ask questions on how to use the equipment. Without this face-to-face encounter, the carrier can deny your claim as not medically reasonable or necessary.

Typically, when the pulmonologist's office owns the equipment, what happens is that patients take home the machine. When they bring it back, the office prints out the recordings, and the physician reviews the results.

Note: Medicare pays for 94762 when the physician obtains the oximeter's results in a "reliable" setting. In other words, the patient's record should identify that the physician preset the oximetry, and the patient cannot adjust the settings. The oximeter must also be capable of producing a printout that documents an adequate number of sampling hours, percent of oxygen saturation, and an aggregate of the results. This information must be available upon request. Medicare may also apply frequency limits for services the physician provides more than three times a year.

Caution: If a portable diagnostic testing company delivers/retrieves the equipment to/from the patient, you are not able to report this service.

Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia and Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta.