You Be the Coder:
Pulse Oximetry at Home
Published on Sat Sep 01, 2001
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Can a pulse oximetry performed during a home visit to certify home O2 services be billed with a higher-level E/M code?
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Answer: Payment for pulse oximetry (94760) is included in the payment for any other billable service reported on the same day. Because pulse oximetry is not separately reportable and is included in the payment for a home visit (99341-99350), the interpretation of the pulse oximetry is attributed to the medical decision-making portion of the E/M service. Specifically, review of the pulse oximetry counts as "one point" (for reviewing or ordering a test according to the medicine section of CPT) in the "amount and/or complexity of data reviewed" category of decision-making.
The review of this test alone will only provide you with documented evidence of "straightforward" decision-making. Because the complexity of medical decision-making is based on two of the three categories (number of diagnosis/treatment options, amount and/or complexity of data reviewed, risk of complications and/or morbidity or mortality), a higher level of complexity may be achieved by evaluating the other two categories of decision-making, especially if no other tests/records are reviewed during the visit.
Refer to the "Complexity of Medical Decision- Making" table under the E/M services guidelines section in CPT 2001 when evaluating medical decision-making. Note that the level of complexity must meet or exceed two categories. Also keep in mind that Medicare considers pulse oximetry to be no different from any other vital sign taken, a contention that is being disputed. Despite its frequent use, it is still just a test and should be coded as such. | |
