Otolaryngology Coding Alert

Question: Under what circumstances will insurers reimburse 94760? Can we report this code with other procedures?


Texas Subscriber


Answer: The Medicare Physician Fee Schedule assigns a -T- status to 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination) and 94761 (... multiple determinations). Medicare, as well as those commercial insurers that follow Medicare guidelines, prohibits you from using 94760 and 94761 on the same day as any other service that payers reimburse under the Physician Fee Schedule.

If pulse oximetry was the only service provided on a given date, the physician is able to report and be paid for 94760 or 94761.

If you-re billing a commercial insurer, you will be subject to its guidelines. Be sure to check with your individual payers. Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta; Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.