Q: Are these the appropriate codes and modifiers to use for a provider who performs tests to determine the need for oxygen as required by Medicare? The claims are currently being submitted as follows:
1. 94620 x2, TC, 59 stress test at rest and exercise
2. 94690 x2, TC, 59 oxygen testing at rest and exercise
3. 94762 x2, 59, overnight pulse oximetry testing on different dates.
A: I am not sure I understand the question you are asking, but I'll try. Medicare requires specific values for oxygen saturation for patients to qualify for home oxygen therapy. Most often the patient is taken for a walk in the physician's office. While walking measured distance and at rest before and after, clinical staff monitors their saturation levels. This is billed with the CPT code 94761 noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations i.e. exercise. The language of "multiple determinations" indicates this code inherently is billed only once per session with the patient.
A simple pulmonary stress test (94620) is a test to evaluate distance, dyspnea, oxyhemoglobin desaturation and heart rate according to the CPT Reference of Clinical Examples. 94690 is an expired gas analysis. I am not sure why you would use either of these codes if you are only looking to test and document O2 saturation on a patient.
I am not sure why you would use some of the codes you listed twice (you indicated X2 in all examples listed). Additionally, using a 59 modifier in the instance of testing would be appropriate if done in a separate session. It might be appropriate to use modifier 59, for example, on tests such as overnight pulse oximetry, which were done on separate nights. I would just be sure there was medical necessity for two nights of testing.
Use of this modifier is highly monitored and frequently overused. For example, if you were doing oximetry measurements on a patient, started oxygen therapy, and then restarted the measuring to see how the patient does with the selected oxygen level, it is not a separate session but a continuation of the original test. Note the code descriptor even says "multiple determinations."
Jill M. Young, CPC, CEDC, CIMC, is president of Young Medical Consulting LLC in East Lansing, Mich., and the 2009-2010 Chair of the American Academy of Professional Coders Chapter Association.
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