Medicare Compliance & Reimbursement - 2016 Issue 6
Reader Question: Coding O2 Therapy, E/M Together Will Deflate Claim
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Article Overview
This reader question and answer explains how oxygen therapy given during an evaluation and management visit is treated for billing purposes, with emphasis on E/M reporting, diagnosis support, and when prolonged services may be relevant. It is aimed at coders and billing staff who handle office/outpatient claims and need to understand how encounter time, documentation, and payer expectations can affect claim submission.
Why This Topic Matters
It helps readers determine how to approach a common outpatient billing scenario involving therapy performed during an E/M encounter and whether additional time-based reporting may apply. The article also flags that payer familiarity with newly introduced prolonged service codes may affect claim processing and documentation needs.
What You Will Learn
- How oxygen therapy provided during an office visit is discussed in relation to E/M reporting
- When prolonged service reporting may be considered in a time-extended encounter
- Why diagnosis support and documentation matter for a claim involving extended face-to-face time
- Why payer-specific familiarity with newer prolonged service reporting may be relevant
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle personnel
- Physician office staff
Codes Discussed
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