Can you tell me more about the medical necessity requirements for pulse oximetry?


Since the implementation of the OPPS in 2000, CMS has encouraged facilities to accurately bill for medically necessary pulse oximetry. The key term is “medically necessary. In all instances, there must be a documented request in the medical record by a physician/practitioner. Parameters for each measurement should be included in the request. In all circumstances, testing would be expected to be useful in the continued management of a patients care particularly in acute exacerbations or unstable conditions (e.g., acute bronchitis in a patient with COPD).

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


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