Laboratory Question for the Week of April 1, 2024

Question:

What considerations should healthcare providers keep in mind regarding the medical necessity criteria when deciding whether to separately bill or bundle codes 88740 and 88741 for transcutaneous procedures?

Answer:

As with all billed services, the question of medical necessity must be addressed when considering whether or not CPT®codes 88740 and 88741 should be separately billed or bundled. When utilized as described by the AMA for the diagnosis of an acute condition with results being used in the treatment of the patient, the CPT codes are billable as medically necessary procedures. However, today’s advancements in technology, with the use of a bedside monitoring system that provides continuous monitoring or trending rather than one-time diagnostic measurements, does not meet the requirement for separate billing. When considering charge strategies for the transcutaneous procedure codes, you should consider the same logic that applies to the monitoring of transdermal oxygen saturations (pulse oximetry). Note that pulse oximetry, when used as a routine monitor rather than a diagnostic tool for the diagnosis or treatment of the patient, is bundled and not separately billed.

This question was answered in our Coding Essentials for Laboratories. For more hot topics relating to laboratory services, please visit our store or call us at 1.800.252.1578, ext. 2.