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?
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.