Pulmonology Coding Alert
NCCI Limits Pulse Oximetry Coding
Question: We bill for sleep study 95807 with overnight pulse ox 94762. Medicare denies the 94762. Are we reporting this incorrectly?
Delaware Subscriber
Answer: Yes. CPT and the National Correct Coding Initiative consider 94762 (Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring [separate procedure]) to be a component of 95807 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist). You cannot report the codes separately. The NCCI edits also make it clear that you cannot use a modifier to break this bundle.
Pulse oximetry is one of the parameters included in a sleep study. CPT therefore considers it an inherent step in the sleep study process and will not pay on both codes.
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