icd 10 code for pulse oximetry

Full Answer

What is the CPT code for pulse oximetry?

Coding and Reimbursement The Current Procedural Terminology (CPT) identifies three codes and descriptors that may be reported for pulse oximetry 94760, 94761, and 94762. The code descriptions and the approximate Medicare reimbursement are as follows:

What does a pulse oximeter measure?

Definition A pulse oximeter is a noninvasive device that measures arterial oxygen saturation levels and pulse rate. The device consists of a sensor attached to the patient’s finger or ear lobe that is linked to a processing unit that delivers a read-out.

Can I Bill for pulse oximetry in the emergency department?

Question: Can I bill for pulse oximetry in the emergency department? Answer: The short answer is no. Even though you cannot bill for the pulse ox CPT code, you frequently can use the information obtained from pulse oximetry as part of your medical decision making.

What is the CPT code for noninvasive ear or pulse oxygenation?

94761 NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; MULTIPLE DETERMINATIONS (EG, DURING EXERCISE) 94762 NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; BY CONTINUOUS OVERNIGHT MONITORING (SEPARATE PROCEDURE) Group 2 Group 2 Paragraph Critical Care Codes Group 2 Codes Code

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Respiratory Therapy and Oximetry Services L33446. CPT ® code 31720 is payable only if it is personally performed by the physician (or qualified Non-Physician Practitioner (NPP)). Note: CPT ® codes 94760, 94761 and 94762 are bundled by the Correct Coding Initiative (CCI) with critical care services.

ICD-10-CM Codes that Support Medical Necessity

The CPT/HCPCS codes included in this Billing and Coding: Respiratory Therapy and Oximetry Services A56730 article will be subjected to "procedure to diagnosis" editing. The following list includes only those diagnoses for which the identified CPT/HCPCS procedures are covered.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

Why is oximetry needed?

Patient has chronic lung disease, severe cardiopulmonary disease or neuromuscular disease involving the muscles of respiration, and oximetry is needed for at least one of the following reasons: Initial evaluation to determine the severity of respiratory impairment. Evaluation of an acute change in condition.

What is the Medicare RVU rate for 2009?

The 2009 Medicare RVU is 0.16, which means that the geographically unadjusted allowable rate is approximately $5.77. Pulse oximetry is considered a technical service involving no physician work component, and such technical services are not payable to physicians or nonphysician providers in any facility setting.

How often should oximetry be performed?

In outpatient or home management for patients with chronic cardiopulmonary problems, oximetric determinations once or twice a year are considered reasonable. In all instances, there must be a documented request by a physician/non-physician provider in the medical record for these services. Regular or routine testing will not be allowed for reimbursement. In all circumstances, testing would be expected to be useful in the continued management of a patient, particularly in acute exacerbations or unstable conditions (e.g., acute bronchitis in a patient with Chronic Obstructive Pulmonary Disease (COPD)) where increased frequency of testing would be considered, on an individual consideration basis, for coverage purposes.

What is arterial pulsation?

Arterial pulsation is used to gate the signal to the arterial component of blood contained within the nailbed. Ear oximetry is a noninvasive method for evaluating arterial oxygenation. Ear oximeters are commonly used in sleep studies. Single and Multiple Determinations (94760, 94761):

What does "appropriate" mean in medical terms?

Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is: Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.

Does Medicare cover oximetry?

Medicare will allow payment for oximetry when accompanied by an appropriate ICD-9-CM code for a pulmonary disease (s) which is commonly associated with oxygen desaturation. Routine use of oximetry is non-covered. Medically necessary reasons for pulse oximetry include:

Is 94762 a CPT code?

The Correct Coding Initiative (CCI) applies to CPT codes 94760, 94761, and 94762. The CCI lists CPT codes that are bundled into other services and not separately reported.

What is the Medicare 94760?

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 ...

Do pulse oximeters charge for blood pressure?

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.