ICD Q & A

Ask the Experts: March 16, 2015


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Question: We currently use CPT code 94761 (multiple oximetry) for charging inpatients and outpatients for a 6-minute walk test while qualifying them for home oxygen. Is this the correct code to use?

Answer: There are now new 6-minute walk test guidelines. The new guidelines are very clear this time that O2 should NOT be titrated during this test, as DISTANCE is the primary measurable objective. 94761/Multiple oximetry to determine O2 requirement has a different measure objective. Is it fair then to assume, that an outpatient, PFT lab could conduct the O2 titration first, followed by the 6-minute walk second, and charge for both? They assess different physiology, and as such, I would imagine, it is fine.

- Nadia Stachowicz, RT, Troy, N.Y.

Answer: Providers are usually reimbursed for performing pulse oximetry testing when accompanied by an appropriate ICD-9 diagnosis code that is used to evaluate conditions which are commonly associated with oxygen desaturation. Routine pulse oximetry testing with absence of signs or symptoms suggestive of desaturation is usually not covered. Use of the appropriate ICD-9 diagnosis code does not guarantee reimbursement, especially if documentation requirements are not met and the physician interpretation of the oximetry results and any related equipment are not listed.

Common reasons for pulse oximetry (CPT 94761) include:

1. Patient exhibits signs or symptoms of acute respiratory dysfunction such as: tachypnea, dyspnea, cyanosis, respiratory distress, confusion and hypoxia.
2. Patient has chronic lung disease, severe cardiopulmonary disease, or neuromuscular disease involving the muscles of respiration, and oximetry is needed for at least one of the following reasons:
    a. Initial evaluation to determine the severity of respiratory impairment.
    b. Evaluation of an acute change in condition.
    c. Evaluation of exercise tolerance in a patient with respiratory disease. \
d. Evaluation to establish medical necessity of oxygen therapeutic regimen.
3. Patient has sustained severe multiple trauma or complains of acute severe chest pain.
4. The patient is under treatment with a medication with known pulmonary toxicity, and it may be necessary to monitor for potential adverse effects of therapy.

source: https://www.networkhealth.com/_files/pdf/Provider/Claims/Pulse_Oximetry_Policy.pdf

- Leola Burke MHSA,CCS, AHIMA-Approved ICD-10-CM/PCS Trainer


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