This paper presents novel methods that integrate lexical prediction of non-verbalized punctuations with Viterbi decoding for Large Vocabulary Conversational Speech Recognition (LVCSR) in a single pass. We describe two different approaches – one based on a modified finite state machine representation of language models and one based on an extension of an LVCSR decoder. We discuss advantages over traditional punctuation prediction approaches based on post-processing of recognition hypotheses, including experimental evaluation of the proposed approach using a state-of-the-art LVCSR decoder. Experiments were performed on a medical documentation corpus and results demonstrate that the proposed methods yield improved punctuation prediction  accuracy while at the same time reducing system complexity and memory requirements.