Forum - Questions & Answers

Jun 11th, 2014 - medcoder02 1 

Pulse Oximetry and E/M

I have a billing deprtament manager questioning why a status T code would appear billable with a column 2 E/M code in the cci edits and I cannot answer her.
94760 appears in column 1 of the current cci edits and 99201,02,03,04,05 and 99211,12,15 (note 13 and 14 are missing) appear in column 2 as components.
First, I thought column 2 was the component column.
Second all of those combinations list are listed with a 1 (of the 0,1,9).

94761 is the same way.
It's creating a ton of confusion for this particular office and I am stumped as to why it's even included in the edits if it's a status T code.

Please help me Betsy

Jun 11th, 2014 - LBAROGIANIS 250 

re: Pulse Oximetry and E/M

I checked on all e/m with my cci edit software and it shows all billable with 94760.

Jun 11th, 2014 - LBAROGIANIS 250 

re: Pulse Oximetry and E/M CPT® 94760 AND E/M CODES


Q: We have a question about Medicare status indicators and procedure discounting. If a claim contains two APCs, one of which has a status indicator 'S', and the other has a status indicator 'T', is either one discounted? What if the 'T' status APC has a higher weight?

If both are 'T' or both 'S', which one is discounted? Will a discount apply only if there are multiple APCs with a status indicator 'T'? We have searched the CMS Web site, but cannot find a definitive answer.

A: You can find the answer to your question in the 'S' and 'T' status indicator descriptions. Status indicator 'S' represents a significant procedure, and is not discounted when you report multiple CPT® codes that group to APCs with multiple 'S' status indicators. Status indicator 'T' is also a significant procedure, but multiple procedure reduction applies.

To answer your specific questions, if there are only two APCs present on a claim (i.e., an ED claim with 12001-59, which has a status indicator of 'T', and 29105-LT, which has a status indicator 'S'), the outpatient code editor identifies both with respective relative weights and status indictators, and both are reimbursed at 100% of APC payment. Neither are discounted because of the singular status indicators reported on the claim.

If both CPT® codes group to status indicator 'S' procedures (i.e. CT scans), then neither is discounted under OPPS and both are paid 100% of APC payment. Remember that in some cases, medical necessity applies before APC payment is made.

If both CPT® codes have a 'T' status indicator, the one with the highest relative weight will be paid at 100% APC payment. Any additional procedures with a status indicator 'T' will be discounted 50% of their APC payment. Remember that with status indicator 'T', there is no limit the number of CPT® codes that you can report, as long as you follow CPT® rules and guidelines and include complete medical record documentation.

Jun 12th, 2014 - Codapedia Editor 1,399 

re: Pulse Oximetry and E/M CPT® 94760 AND E/M CODES

On the physician side, billing Part B on a CMS 1500.

94760 has a status indicator of T.

In the claims processing manual, this is described as:

There are RVUs and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made.

Jun 12th, 2014 - medcoder02 1 

re: Pulse Oximetry and E/M CPT® 94760 AND E/M CODES

I know, but my question is why does it show a "1" when run against e/m codes in the cci edits?
The information in the cci edit conflicts with the status code definition.
Odd, I know that it's not going to be paid and I know why but I really want to know how it ended up in the edits. Have I missed something?

Jun 12th, 2014 - nmaguire   2,606 

re: Pulse Oximetry and E/M CPT® 94760 AND E/M CODES

Because if it is the only thing you do that day, it would get paid (highly unlikely!)

Jun 13th, 2014 - LBAROGIANIS 250 

re: Pulse Oximetry and E/M CPT® 94760 AND E/M CODES

I use code manager(ama) and it does not have a "1" or anything on this code, it does say the rvu is .07, the e/m code of 99215 is 3.66, and there is no cci edits on either code and it appears that it can be billed together. But really the rvu on the 94760 is so small, how much can you really be paid? I am in florida, area 99- and if I billed 94760 I would be paid $3.28..

p.S. This is an example of getting a coding question sent to your email without any of the follow up questions or the original question displayed. Thank god I have a somewhat good memory.

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