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pulse oximetry

  1. #1
    Default pulse oximetry
    Medical Coding Books
    we bill cpt 94760 and/or 94761 - usually 94760 which is for pulse oximetry. in almost all instances of our denials the patient has come in and complained of shortness of breath and the dr ordered a pulse oximetry. 786.05 is a covered dx per the LCD but our denial is C0-B15 which is payment included in allowance for another procedure. they are saying it's included with the office call. the LCD is a little unclear to me whether it's covered under PART B or not or if it's only allowed in a hospital setting not a physican's office.
    Does anyone know anything about this? what's covered, what's not? I have been transferred to a level 2 person @ medicare 2 days in a row and have been on hold for an hour and a half each time, any insight would be helpful at this point!

  2. #2
    In my experience Pulse ox is always included in the office visit. I have never seen one get paid. Maybe others have a trick I dont know about, but from what I understand it is included in the visit.
    Susie Corrado, CPC
    ENT Coding/Billing

  3. #3
    north seattle wa
    This is from the pulse ox LCD
    "Procedures 94760 and 94761 are considered by CMS to be laboratory procedures. Therefore, they are technical services and are not payable to a physician/provider in an inpatient or outpatient hospital setting."

    We do the overnight pulse ox and have been getting paid for that-94762.

    Hope this helps

  4. Default
    Hope you can help ! I am finding that 94762 can only use a TC modifier. Do you bill the 94762 without the 26 (global) and get paid? Medicare, BC, any others?

    Thanks for the help

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