SPIROMETRY, PULSE OX and demo

kdriscoll

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We are having trouble consistenely getting CPT 94010, 94664 and 94760 paid whether we use a modifier(s) or not. What is the best/correct way to get these three reimbursed?
Any advise someone can offer would be GREATLY appreciated!
 
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LOVE2CODE

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We are having trouble consistenely getting CPT 94010, 94664 and 94760 paid whether we use a modifier(s) or not. What is the best/correct way to get these three reimbursed?
Any advise someone can offer would be GREATLY appreciated!
I have no success either in getting the above codes paid....Insurance co's states it is included in the E/M code...


YTH, CPC
 
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Pulse Oximetry

http://www.cignagovernmentservices.com/partb/help/faqs/general/faq_07_25_07.html



Q2. I'm trying to bill a claim for an office visit and pulse oximetry (94761), why is my charge for the pulse oximetry being denied?

A2. Effective for services on and after January 1, 2000, the Centers for Medicare & Medicaid Services (CMS) changed the status for code 94761 from "A" (active) to "T" (injection). This means that although this code is not performed as an injection, the relative value units fall under the same category as some injection procedures. Code 94761 is only paid if there are no other services, payable under the physician fee schedule, billed on the same date, by the same provider. If an office visit was billed and allowed for payment, then payment cannot be made for code 94761. This service would be bundled into the office visit.
The pulse oximetry LCD (Local Coverage Determination) can be found at the following link: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=6465&lcd_version=16&show=all
 
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