Pulmonology Coding Alert

Answer: As you have mentioned, you’ll report 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination) and 94761 (…multiple determinations [e.g., during exercise]) when your pulmonologist performs pulse oximetry. You should use the CPT® code 94760 for a single reading, while you’ll report 94761 for two or more readings. For instance, if your pulmonologist takes a patient’s resting pulse oximetry level, has the patient walk around, and then checks the level again while the patient is walking, you would code 94761.

You can report these codes for reimbursement only when the pulmonologist’s staff measures either 94760 or 94761 in the office setting, and the patient receives no other service on that day.

Payers include 94760 and 94761 as elements of other reimbursed services such as a spirometry (94010), simple pulmonary stress test (94620) and respiratory therapy services (G0237, G0238, and G0239). Additionally, as you have pointed out, these codes cannot be reported separately with an E/M service code. If you report a pulse oximetry separately, you will not receive any additional payments for this service in addition to the other procedures or the E/M service performed.

This is because Medicare assigns a “T” status for 94760 and 94761. That means payers always bundle reimbursement for these two pulse oximetry services and include it with the payment of any other service provided on the same day.

So, you cannot get separate reimbursement for a pulse oximetry by trying to use a modifier with any of the codes.