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ED Coding and Reimbursement Alert

Reader Questions:

Leave Pulse Ox Code Off ED Claims

Published on Sun Feb 27, 2011

Question: A patient with a diagnosed history of sleep apnea reports to the ED complaining of an exacerbation of his condition. The nonphysician practitioner (NPP) performs history and examination, and then performs pulse oximetry. The physician then interprets the oximetry results, instructs the patient to follow up with his pulmonologist, and sends him home. I was going to report an ED E/M and 97560 for the oximetry interpretation. A fellow coder told me that oximetry interpretation is not a billable ED service, so I am hesitating. How should I code this scenario?Texas SubscriberAnswer: Both Medicare and CPT have literature indicating that you should not report pulse oximetry interpretation services in the ED. On the claim, report the following:The appropriate level ED E/M code based on encounter notes. Your encounter resembles a 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an [...]
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