Pulmonology Coding Alert

Do you automatically write off pulse oximetries? If so, you could be losing out on reimbursement. Some payers reimburse pulse oximetry if it's a separately identifiable service, so don't automatically bundle it into other services or procedures.

Pulse oximetry is a noninvasive measurement of oxygen saturation of hemoglobin in arterial blood stated as a percentage, says Antoinette Revel, CPC, a coding expert and nurse practitioner working at Healthcare Consulting Services in Warrington, Pa. The codes for pulse oximetry are: 94760 Noninvasive ear or pulse oximetry for oxygen saturation; single determination
94761 ... multiple determinations (e.g., during exercise)
94762 ... by continuous overnight monitoring (separate procedure). Pulmonologists will use pulse oximetry on critically ill patients with pulmonary problems, she says. The pulse oximetry allows for continuous monitoring of intrapulmonary shunts and the adjustments of oxygen and positive pressure without using arterial blood gas, an invasive procedure. Asudden change in the pulse oximetry reading may serve as an early warning of an alteration in a patient's oxygen intake and need for immediate assessment just in case, for example, secretions have obstructed a patient's airway or a ventilator has been accidentally disconnected, she says. Pulse oximetry may be medically necessary to evaluate conditions including asthma, pneumonia, bronchitis, and patients with chronic lung disease, in addition to other conditions. Most coders include the work done from pulse oximetry in the appropriate E/M code for the visit, which is accurate. In certain circumstances, however, you can separately report pulse oximetry codes as an outpatient service. The hospital covers it when done in a facility. When You Can Report Pulse Oximetry, Use Caution Report pulse oximetry when it is reasonable and medically necessary, Revel says.

You can separately report pulse oximetry when it's done for making a diagnosis or assisting with medical decision-making in relationship to the chief complaint, says Jan Loomis, director of coding and documentation at TeamHealth West in Pleasanton, Calif. Pulse oximetries of a patient with asthma would be a good example of when this happens, she says.

For most payers, however, to separately report pulse oximetry, the test must go beyond routine testing and the recording of a numerical result. It is the physician's interpretation of the numerical result that contributes to the patient's care plans, says Mike Ganovsky, MD, CPC, CFO. Although you're allowed to bill for this interpretation, you should "tread lightly" when it comes to reporting pulse oximetry as a separate service, says Robert La Fleur, MD, FACEP, president of Medical Management Specialists. "In this day and age, pulse oximetries are done almost like a vital sign," he says. Consider whether the physician's interpretation of pulse oximetry warrants a separate charge any more than his interpretations of pulse, blood pressure [...]