Coding Consult

March 18, 2005

Extra infusion time; oximetry coverage; meet-and-greet charges

Answers to your questions about . . .

A The CPT manual does not specifically address this question regarding thresholds for minimum time requirements to report these services. But CPT Assistant states, "In the instance when an infusion lasts over one hour, but less than a full additional hour, modifier -52 (reduced services) should be appended to code 90781 to indicate that the time beyond the first hour was less than an hour."

Oximetry coverage Q Under what circumstances will insurers reimburse 94760? Can we report this code with other procedures?

A Your best bet is to check with your local carrier before reporting code 94760 (noninvasive ear or pulse oximetry for oxygen saturation; single determination) because many Medicare and commercial carriers have developed differing coverage policies for the oximetry code. No single set of guidelines will apply to all practices.

For example, First Coast Service Options, the Medicare carrier for Florida, bundles 94760 in with multiple determination oximetry code 94761 (. . . multiple determinations [e.g., during exercise]) when the physician performs the services on the same day. Furthermore, the carrier won't pay for either 94760 or 94761 with any other Physician Fee Schedule services you bill on the same day. Noridian Administrative Services, which covers several states including North Dakota and Nevada, also bundles 94760 and 94761 with other payable services, but they allow payment for oximetry when the service is accompanied by an appropriate ICD-9-CM code that shows medical necessity. TrailBlazer Health Enterprises, a Medicare carrier for several states, doesn't say that the codes will be bundled with other services, but specifies ICD-9-CM requirements that must be met. If you're billing a commercial insurer, pay close attention to its guidelines.

Meet-and-greet charges Q Can we report an E&M code for my "meet and greet" sessions with new patients? Perhaps unlisted procedure code 99429?

A You can probably please patients and build your practice with meet-and-greet visits, but insurance carriers don't consider them medically necessary. So don't use 99429 or any other code, and, of course, you shouldn't bill the patient.

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