Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.
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. Considering the pulse oximeter readings and incorporating that information into the data that you are utilizing to fully evaluate and manage a patient definitely demonstrate an increased complexity of medical decision making. Although a pulse oximeter reading is frequently obtained on many ED patients, your charting should demonstrate the medical necessity of obtaining and interpreting the reading on that particular patient.
To find out more about why you cannot routinely bill the pulse ox CPT code in the emergency department, visit the pulse ox FAQ at www.acep.org/reimbursement.
Brought to you by the ACEP Coding and Nomenclature Committee.
Dr. Lempert is chief medical officer, health care financial services,, at TeamHealth, based in Knoxville, Tennessee.