Pulse Oximetry Interpretation FAQ
FAQ 1: Can I bill Medicare for
pulse ox interpretation in the ED (94760-94762)?
The simple answer is
no. And here is the reason (or reasons)
- The CMS (Medicare) National
Physician Fee Schedule Relative Value File does not assign any physician work for
these codes. This usually indicates
codes that are unlikely to be billable by emergency providers.
- On the CMS fee schedule these
codes are listed as Status A. Which
means these services are only paid if there are no other services payable under
the physician fee schedule billed on the same date by the same provider for the
same patient. If any other services payable under the physician fee schedule
are billed on the same date by the same provider for the same patient, these Status
A services are bundled into the physician services for which payment is made.
- The PC/TC indicator for these
codes on the CMS fee schedule is 3. This
indicates Technical Component Only Codes.
These are codes that are covered only as diagnostic tests and therefore
do not have a related professional code. Modifiers 26 and TC cannot be used
with these codes.
FAQ 2: Can I bill non-Medicare patients for pulse ox interpretation in
The answer is still no. The above answers are all from CMS, which
does only govern Medicare claims. But
CPT policy covers all claims utilizing CPT codes and nomenclature. Per the CPT Information Services: “From a CPT
Coding perspective, the purpose of codes 94760 and 94762 is to identify that
the physician owns the equipment used for the oximetry and performed the
interpretation of the results. Therefore, if the physician does not own the equipment used to perform the ear pulse
oximetry, it would not be appropriate to report code 94760 or
94762 to identify his or her services. Interpretation of the ear or pulse
oximetry results performed by the physician when the equipment is not owned by
the physician (e.g. performed on
hospital-owned equipment) is considered part of the medical decision
making component of the evaluation and management (E/M) service codes".
FAQ 3 If the pulse ox
interpretation is considered part of the E/M service can I count it additionally
when determining the level of MDM (Medical Decision Making)?
The purpose of MDM is to represent
the complexity of the physician‘s thought processes in evaluating and managing
a given patient’s present, past, and potential medical problems. In many emergency departments, oxygen
saturation is documented as a part of the intake process for every
patient. The solitary act of recording
the pulse ox reading by the nursing staff might not seem to communicate any
added complexity of thought by the ED physician. For example, if a patient with an isolated ankle
sprain and no oxygen saturation coupled medical conditions has a pulse ox
However, it may be reasonable to take pulse ox
interpretation into account in cases where the patient’s medical condition(s) warrants
the ED physician using the saturation reading as part of the diagnostic/management
process: for shortness of breath, chest
pain, history of respiratory ailments, child
with bronchiolitis, etc. In such cases,
it would be prudent to document the relevance of pulse ox interpretation in the
The American College of Emergency Physicians (ACEP) has
developed the Reimbursement & Coding FAQs and Pearls for informational
purposes only. The FAQs and Pearls have been developed by sources
knowledgeable in their fields, reviewed by a committee, and are intended to
describe current coding practice. However, ACEP cannot guarantee that the
information contained in the FAQs and Pearls is in every respect accurate,
complete, or up to date. The FAQs and Pearls are provided "as is"
without warranty of any kind, either express or implied, including but not
limited to, the implied warranties of merchantability and fitness for a
particular purpose. Payment policies can vary from payer to payer.
ACEP, its committee members, authors or editors assume no responsibility for,
and expressly disclaim liability for, damages of any kind arising out of or
relating to any use, non-use, interpretation of, or reliance on information
contained or not contained in the FAQs and Pearls. In no event shall ACEP be
liable for direct, indirect, special, incidental, or consequential damages
arising out of the use of such information or material. Specific coding or
payment related issues should be directed to the payer. For information about
this FAQ/ Pearl, or to provide feedback, please contact David A. McKenzie, CAE,
Reimbursement Director, ACEP at (972) 550-0911, Ext. 3233 or firstname.lastname@example.org.