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Pulmonology Coding Alert

Reader Questions:

"Separate Sessions" Define Modifier 59's Limitation

Published on Mon Feb 28, 2011

Question: According to coding edits 94762 (continuous overnight monitoring) is considered a component of 94761 (multiple pulse ox determinations). In what circumstances could one charge both procedures with 94762 having a modifier? In what circumstances would one only charge 94761 when both overnight pulse ox and multiple pulse ox determinations are done during the day?Answer: CPT lists 94761 (Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations [e.g., during exercise]) with a "T" status on the Medicare Physician Fee Schedule. This means that you cannot report this service on the same day as any other billable service. Therefore, you cannot report these two services together.
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