Health Information Management

Understand when to bill for pulse oximetry separately

APCs Insider, October 5, 2007

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QUESTION: I would like to know whether you have any information on when we can bill "pulse ox random/continuous" as a separate item on a claim and when we should bundle this service into the treatment room charge?

ANSWER: When a provider renders a diagnostic service to a patient upon physician order, it is medically necessary and represents a cost of care different from a patient who does not receive the service. When this is the case, you may be able to bill the service separately. Someone posed a question to Medicare regarding whether providers should separately charge for pulse oximetry, even though Medicare packages the HCPCS and does not generate separate additional payment. You can view Medicare's answer p. 52135 of the Federal Register dated August 9, 2002, which states: ". . .hospitals must separately report the HCPCS code and a charge for pulse oximetry. . ."

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