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Golden Rule - Pulse Oximetry with Evaluation & Management

CPT Code Description: -

  • 94760 - Noninvasive ear or pulse oximetry for oxygen saturation; single determination
  • 94761 - Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise)
The provider and or other qualified healthcare professional takes the oxygen 
saturation using the a sensor on the ear or finger from the patients.

To perform this service, the doctor places a sensor, such as one in the form of a clip, on the patient’s earlobe or fingertip.

The sensor uses a light shining through the body part to measure the oxygen saturation, detecting the differences in the ways blood cells with and without oxygen reflect light.
 
The Oxygen saturation, is also called as O2 sat, and the percentage of hemoglobin carrying oxygen molecules.
 
Guidelines: -

The CPT Codes ranges from 94010 to 94799 include laboratory procedure(s) and interpretation of test results.

If a separate identifiable evaluation and management service is performed on the same day, the appropriate E/M service code can be billed separately. Like,
  • New or Established Patient Office or Other Outpatient Services (99202 to 99215),
  • Office or Other Outpatient Consultations (99242 to 99245),
  • Emergency Department Services (99281 to 99285),
  • Nursing Facility Services (99304 to 99316),
  • Home or Residence Services (99341 to 99350),
The mentioned above listed CPT codes may be reported with modifier 25 based on the NCCI edits guidelines in addition to the 94010-94799.

General Information: -

The pulse oximetry codes are not reportable with any other service performed on the same day.

There is no NCCI edits for this CPT codes, but as per the CMS guidelines, the Medicare Physician as categorized into the "T" status code, which means 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.

Additional Information: -

Pulmonary function tests (94011-94013) are reported for measurements in infants and young children through 2 years of age.

Pulmonary function testing measurements are reported as actual values and as a percent of predicted values by age, gender, height, and race.

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