Pulse Oximetry

Pulse Oximetry 

Pulse Oximetry is a non invasive method for monitoring a patients Oxygen saturation.

Pulse oximetry measures oxygen saturation using a non-invasive probe (In its most common (transmissive) application mode, a sensor device is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot.) This is done by measuring light absorption of oxygenated hemoglobin and total hemoglobin in arterial blood.

Procedure Description:

The physician places a sensor, in the form of a clip, on the patient’s 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. Oxygen saturation, is the percentage of hemoglobin carrying oxygen molecules. Hemoglobin is the protein in the red blood cell that carries oxygen to the tissue and returns carbon dioxide to the lungs. The sensor transmits the data to a computer unit that displays the result.

Use CPT code 94760 when the physician takes a single measurement.

Use CPT code 94761 when the physician takes multiple measurements.

Use CPT code 94762 when the physician monitors the oxygen saturation continuously overnight.

CPT Codes are mentioned below,

CPT 94760 - NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; SINGLE DETERMINATION

 

CPT 94761 - NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; MULTIPLE DETERMINATIONS (Eg, DURING EXERCISE)

 

CPT 94762 - NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; BY
CONTINUOUS OVERNIGHT MONITORING (SEPARATE PROCEDURE) 

CPT 94762 is considered medically necessary when performed for one of the following circumstances:
1. The patient has a condition for which intermittent arterial blood gas sampling is likely to miss important variations, or

2. The patient has a condition resulting in hypoxemia and there is a need to assess supplemental oxygen requirements and/or a therapeutic regimen.

Medicare will allow payment for oximetry when it would be assigned by an appropriate diagnosis code for a pulmonary diseases which is commonly associated with oxygen desaturation.

Medically necessary for pulse oximetry are mentioned below,
 

1. Signs / symptoms of acute respiratory dysfunction such as,

•      Tachypnea
•      Dyspnea
•      Cyanosis
•      Respiratory distress
•      Hypoxia

2. Chronic lung disease, severe cardiopulmonary disease, or neuromuscular disease involving the muscles of respiration,

•   Initial evaluation to determine the severity of respiratory impairment,
•   Evaluation of an acute change in condition,
•   Evaluation of exercise tolerance in a patient with respiratory disease, or
•   Evaluation to establish medical necessity of oxygen therapeutic regimen.

3. Patient has sustained severe multiple trauma or complains of acute severe chest pain

4. Patient is under treatment with a medication with known pulmonary toxicity and oximetry is medically necessary to monitor for potential adverse effects of therapy.

For LCD  / ICD-9 Codes that Support Medical Necessity please check in the below mentioned link,

https://www.virtuox.net/Dyndocs/Documents/LCDforOximetry.PDF

Proper documentations is required to assign appropriate Pulse Oximetry CPT codes:

Office or home health care records or certification of medical necessity should clearly document the
reason for the testing, its frequency and the results.

Only one number of services per day will be allowed for testing at a reasonable frequency and if medically necessary regardless of whether the patient is sitting, standing, or lying, with or without exercise or oxygen use, unless medical necessity can be demonstrated for additional needs. 

More frequent testing may be allowed when there is documentation of an acute exacerbation of a chronic pulmonary disease or other acute illnesses with signs indicating or suggesting increased hypoxemia.

When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary.

Routine use of Pulse oximetry is non-covered service. The results of tests performed by a durable medical equipment supplier to qualify patients for home oxygen service are not covered.