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Victoria Posted 6 Year(s) ago

Hello!We've been using cpt (94760 & 94761)pulse oximetry test,finger probe,however Medicare bundling it to E/M office visit.We found the ff cpt;94010, 94060 & 94620,pls advise which code is applicable when its done during the office visit(E/M)? URGENT PLS!!!THANK YOU

SuperCoder Posted 6 Year(s) ago

Don’t automatically assume that billing for pulse oximetry precludes separate payment from Medicare.

You can bill for pulse oximetry if it is the only service the physician performs. According to CMS policy on T-status codes, which include 94760 and 94761: “If the status-T service is performed by itself it will be considered for payment.” You can also bill pulse oximetry in addition to other services provided by the same provider on the same date if the additional procedures are not payable under the Physician Fee Schedule. According to CMS, only if the T-status (i.e., pulse oximetry) procedure is performed on the same day as another Medicare Physician Fee Schedule service will it be “denied as bundled.”

Watch out for those E/M codes when reporting to any Medicare carrier. Even though CPT suggests that you can assign pulse oximetry codes in addition to an E/M service, Medicare won’t pay for both. As always, be aware that submitting a code that you know Medicare won’t pay can lead to compliance problems if the carrier pays by accident.

Check your local medical review policies (LMRPs) because they may have additional clauses that explicitly deny, in all circumstances, separate payment for 94760 and 94761. The local Medicare medical policy bulletin for Revel’s area states, “Codes 94760 and 94761 are bundled on the Medicare Fee Schedule. Separate payment is not allowed for these services.”

The component codes for 94620 are 94760, 94761. Hence i will prefer 94620.

Posted by Victoria, 6 Year(s). There are 2 posts. The latest reply is from SuperCoder.

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