Pulmonology Coding Alert

Question: Our pulmonologist sends a Medicare patient home with equipment so the patient can self-administer overnight pulse oximetry. How should I report this service?

Alabama Subscriber

Answer: If your practice owns the oximetry equipment, you can report the overnight oximetry with 94762 (Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring [separate procedure]). However, you'll have to meet certain requirements before Medicare will accept the code.

During the office visit in which the pulmonologist gives the patient the oximetry equipment, your pulmonologist must visit face-to-face with the patient.

During this encounter, the pulmonologist should make sure the patient understands how to use the equipment, and allow the patient to ask questions about the oximetry.

Note: You should also prove that the pulmonologist obtains test results in a "reliable" setting. This means that the patient record should show that the pulmonologist set the oximeter so the patient could not adjust the settings.

And the device must provide a printout that documents an adequate number of sampling hours, percent of oxygen saturation, and an aggregate of the results (this printout cannot come from a device the patient uses to log oximetry information). Medicare payers may ask for this information to prove medical necessity for 94762, so it is a good idea to include it in the patient's file.

Remember: The pulmonology practice must give the patient the oximetry equipment and instruct the patient on its use in order to report 94762. You cannot report 94762 if a testing company delivers and picks up the oximetry equipment from the patient.