ED Coding & Reimbursement Alert - 2016 Issue 12
Reader Question: Careful When Coding Oximetry Separately From E/M
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Article Overview
This reader question addresses a common outpatient coding and reimbursement issue involving pulse oximetry reported with evaluation and management services. It is written for coders and billing staff who need to understand why certain same-day services are treated as bundled, how payer policy can differ from claim-edit expectations, and what broad categories of services are affected. The article also references Medicare status indicators and discusses the general impact on separate payment for pulse oximetry and related respiratory services.
Why This Topic Matters
Understanding how payers treat same-day pulse oximetry and evaluation and management services helps prevent denied claims and incorrect attempts to unbundle services. The topic matters to practices that bill office visits, consultations, and respiratory testing.
What You Will Learn
- How same-day pulse oximetry and evaluation and management services may be treated by payers
- Which broad outpatient service categories are discussed in relation to bundling
- How Medicare status indicators can affect reimbursement treatment
- Why certain respiratory and pulmonary services are mentioned in connection with pulse oximetry billing
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle staff
- Outpatient clinic staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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