Understanding Basics of Polysomnography and Sleep Testing Billing

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Understanding Basics of Polysomnography and Sleep
Testing Billing
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Understanding Basics of Polysomnography and Sleep
Testing Billing

• Basics of Polysomnography and Sleep Testing
• About 40 million people in the United States
  suffer from sleep problems every year. Not
  getting enough sleep for a long time can cause
  health problems. Many sleep disorders can be
  managed by primary care physicians however, when
  abnormal sleep patterns are not easily
  explainable and further evaluation is necessary,
  expert opinion and sleep studies may be needed.
  Polysomnography (PSG) refers to the continuous
  and simultaneous monitoring and recording of
  various physiological and pathophysiological
  parameters of sleep furnished in a sleep
  laboratory facility that includes physician
  review, interpretation and report. A technologist
  supervises the recording during sleep time and
  has the ability to intervene, if needed. The
  studies are performed to diagnose a variety of
  sleep disorders and to evaluate a patients
  response to therapies such as continuous positive
  airway pressure (CPAP). As a primary care
  physician, to get an accurate reimbursement, lets
  understand basics of Polysomnography and Sleep
  Testing billing.
• Polysomnography and Sleep Testing Coding
• Some of the commonly used CPT codes for
  Polysomnography and Sleep Testing are as
  mentioned below. These CPT codes are covered by
  Medicare (with proper documentation), you can
  check payer specific reimbursement guidelines for
  exact coverage.
• Non-attended sleep studies should be billed with
  the CPT/HCPCS code that most accurately describes
  the service.
• CPT code 95811 alone should be billed for split
  night studies as CPT code 95811 in this instance
  is inclusive of CPT code 95810.

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Understanding Basics of Polysomnography and Sleep
Testing Billing

• (Polysomnography age 6 years or older, sleep
  staging with 4 or more additional parameters of
  sleep, attended by a technologist)
• For a study to be reported as polysomnography
  (PSG), sleep must be recorded and staged and
  directly attended by a qualified technologist.
  Report with modifier 52 if less than 6 hours of
  recording or in other cases of reduced services.
• CPT codes 95782, 95783, 95808, 95810, and 95811
  include sleep staging. Medicare would not expect
  to see separate billings for an EEG, EOG, and/or
  EMG in addition to these codes.
• CPT code 95808 includes reimbursement for one to
  three additional parameters. CPT codes 95782,
  95783, 95810 and 95811 include four or more
  additional parameters. Therefore, Medicare would
  not expect to see separate billings for
  additional parameters in addition to codes 95782,
  95783, 95808, 95810, or 95811.
• Additional parameters of sleep include.
• ECG
• Airflow
• Ventilation and respiratory effort
• Gas exchange by oximetry, transcutaneous
  monitoring or end tidal gas analysis
• Extremity muscle activity and motor activity
  movement
• Extended EEG monitoring
• Penile tumescence
• Gastroesophageal reflux

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Understanding Basics of Polysomnography and Sleep
Testing Billing

• Continuous blood pressure monitoring
• Snoring
• Body positions
• Documentation Requirements
• All documentation must be maintained in the
  patients medical record and made available to
  the contractor upon request.
• Every page of the record must be legible and
  include appropriate patient identification
  information (e.g., complete name, dates of
  services). The documentation must include the
  legible signature of the physician or
  non-physician practitioner responsible for and
  providing the care to the patient.
• The submitted medical record must support the use
  of the selected ICD-10-CM code(s). The submitted
  CPT/HCPCS code must describe the service
  performed.
• An order from the treating physician/nonphysician
  practitioner as required by CFR, Title 42, Volume
  2, Chapter IV, Part 410.21 (a) Ordering
  diagnostic tests.
• When billing for a sleep disorder test, the
  ordering physicians NPI must be indicated on the
  claim form and the order kept on record.
• Documentation must support that the
  accreditation, credentialing, and training
  requirements as stated in the LCD were met for
  the clinic, technologist, and physician.

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Understanding Basics of Polysomnography and Sleep
Testing Billing

• Applicable CPT Code
• Group 1 Codes
• 95782 Polysom lt6 yrs 4/gt paramtrs
• 95783 Polysom lt6 yrs cpap/bilvl
• 95807 Sleep study attended
• 95808 Polysom any age 1-3gt param
• 95810 Polysom 6/gt yrs 4/gt param
• Group 2 Codes
• 95811 Polysom 6/gtyrs cpap 4/gt parm
• Group 3 Codes
• 95805 Multiple sleep latency test
• Group 4 Codes
• 95800 Slp stdy unattended
• 95801 Slp stdy unatnd w/anal
• 95806 Sleep study unattresp efft
• G0398 Home sleep test/type 2 porta
• G0399 Home sleep test/type 3 porta
• G0400 Home sleep test/type 4 porta

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Understanding Basics of Polysomnography and Sleep
Testing Billing

• Evaluation and Management (E/M) Codes
• Sleep physicians also use Evaluation and
  Management (E/M) codes to bill for office visits.
  Evaluation and management codes are restricted to
  physicians and other qualified advanced nurse
  practitioners (NPs, PAs, etc.). Technologists
  cannot bill independently but they can bill
  incident to the physician (if certain guidelines
  are followed).
• 99202 Level 2 new patient office visit
• 99203 Level 3 new patient office visit
• 99204 Level 4 new patient office visit
• 99205 Level 5 new patient office visit
• 99211 Level 1 established patient office visit
• 99212 Level 2 established patient office visit
• 99213 Level 3 established patient office visit
• 99214 Level 4 established patient office visit
• 99215 Level 5 established patient office visit
• Legion Health Care Solutions is a leading medical
  billing company providing complete billing and
  coding services to ensure accurate insurance
  reimbursement for your practice. We shared basics
  of Polysomnography and Sleep Testing billing for
  physician reference, for accurate insurance
  coverage and applicable procedure codes, refer to
  payer specific billing guidelines and
  reimbursement policies. To know more about our
  primary care billing and coding services, contact
  us at 727-475-1834 or email us at
  info_at_legionhealthcaresolutions.com

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