Pulmonology Coding Alert

Question: Is it true that I should only report 94762 as a technical component? Therefore, if a physician in our practice interprets the overnight pulse oximeter reading, I should not bill any code unless the patient is physically present in the office; is that correct?

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? Should I also report an additional appropriate E/M code or should I report 94762 once the patient returns the oximeter and the physician interprets the reading?

Wisconsin Subscriber

Answer: Code 94762 (Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring [separate procedure]) describes noninvasive ear or pulse oximetry for O2 saturation by continuous overnight monitoring and does not include payment for any work the physician completed. Code 94762 is a technical code in that it does not involve any physician-work RVUs.

If you own or lease the equipment that the patient is using, you can bill for the overnight oximetry. You should use 94762. You don’t have to attach a modifier.

Typically, when the physician’s office owns the equipment, patients take home the machine. The patient’s record must document that the oximeter is self-sealed and incapable of being adjusted by the patient. The device must be capable of providing a printout that records an adequate number of sampling hours (a minimum of four hours should be recorded), percent of oxygen saturation and an aggregate of the results. This information must be available if requested. When the patient returns the oximeter, the office prints out the recordings, and the physician reviews the results. You should report 94762 for the date of service when the patient returns the overnight pulse oximetry after verifying the recording adequacy.

Before you bill 94762 for overnight desaturation oximetry, you have to meet Medicare’s reporting guidelines. Generally, the service must be performed at a pulmonologist’s (or other qualified health care provider’s) request. For both office and home testing, Medicare requires that the physician who provides the oximetry verify and clearly document the medical necessity of the testing, its frequency and the results. An appropriate history and physical exam and progress notes must also be available for review to support the patient’s condition that warrants testing. This direct encounter also 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 supportive documentation, the carrier can deny your claim as not medically reasonable or necessary.

Remember: The other codes for ear or pulse oximetry — 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination) or 94761 (…multiple determinations…) — also do not cover work the physician may complete. You should not report these codes if the physician provided any other billable service on the same day.