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Billing for 94760 pulse oximetry

  1. #1
    Default Billing for 94760 pulse oximetry
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    Can you bill 94760 with an E&M visit and do you need to use mod-25?
    We have not been billing for 94760 but plan on starting.

  2. #2
    Default
    It has been my experience that insurance companies do not reimburse separately for 94760 even when modifier 25 is used on the E/M. They tend to bundle it with the E/M code.

    I hope this helps!

    Teresa Collins, CPC

  3. Default
    You can not bill 94760 with an office visit. The insurance companies will deny because they consider it part of the constitutional. We were at one time billing both and were ALWAYS denied the pulse ox.

  4. #4
    Default
    94760 is a Medicare status T code, which says :

    There are RVUs and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made.

    Which basically means if the E/M is payable for the same DOS, then this 94760 code is not going to be.

  5. #5
    Default Rules vs Right?
    So, if our Dr states she wants 94760 on the claim since they actually did it, even though it will it not get paid, what is RIGHT? Thank you, Brandy

  6. #6
    Location
    Dover Seacoast New Hampshire
    Posts
    1,971
    Default
    Billing the 94760 with an E&M could be considered 'unbundling'. I'd leave it off the claim.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  7. #7
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    Thank you so much Pam...I appreciate you taking the time to help me! God Bless, Brandy, CPC

  8. #8
    Location
    Austin, Texas
    Posts
    467
    Default
    Pulse oximeter charges used to be paid, back when the equipment was expensive. Advise your doctor that now a pulse ox is similar to taking a blood pressure reading, and you don't charge separate for that tool. The pulse ox is part of the diagnostics that aids in medical decision making, complexity, and the lower the pulse ox reading, then the more complicated the medical decision making. So it is fair to be part of the E & M CPT, just make sure the documentation supports the level of coding.

  9. #9
    Thumbs up Thank u
    Thank you for taking your time to respond to my question? You pointed out some great points!! Im never disappointed when I post my questions here....you guys ALWAYS DELIVER!! Thank you so much!

  10. Default 94760 for vitals
    Should CPT codes 94760, A4670 AND 2010F be used for taking vitals? (this is for ER department coding

    Thank you,
    Debbie

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