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Question:
I looked up CPT® code 94762—pulse oximetry; continuous overnight determination—in Appendix B of the October 2018 OPPS to find the payment, and I happened to see a SI of Q3 for it. What does this mean?
Answer:
Under the outpatient prospective payment system (OPPS) reimbursement guidelines, some services are designated as “special packaged” or “composite ambulatory payment classification (APC)” procedures. A code that falls into these groups is assigned an APC status indicator (SI) of “Q3” and categorized as conditionally packaged. This means that the procedure will be reimbursed according to APC assignment when it appears on a claim with no other SI “Q3” services (codes that may be paid through a composite APC). When multiple procedures within the conditionally packaged category of “Q3” appear on the claim with the same date of service, a single packaged payment will be made that includes the composite APC.
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This question was answered in the 2018 edition of our Coding Essentials for RT/Pulmonary Function. For more hot topics relating to respiratory therapy services, please view our store, or call us at 1.800.252.1578 ext. 2.
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
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