Understanding Basics of Polysomnography and Sleep Testing Billing

1. Understanding Basics of Polysomnography and Sleep Testing Billing

2. Understanding Basics of Understanding Basics of Polysomnography Polysomnography and Sleep Testing Billing 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 patient’s 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. Email us at: kbradley@legionhealthcaresolutions.com Call us at: 727-475-1834

3. Understanding Basics of Understanding Basics of Polysomnography Polysomnography and Sleep Testing Billing and Sleep Testing Billing • • 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. (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: o ECG o Airflow o Ventilation and respiratory effort o Gas exchange by oximetry, transcutaneous monitoring or end tidal gas analysis o Extremity muscle activity and motor activity movement o Extended EEG monitoring o Penile tumescence • • • Email us at: kbradley@legionhealthcaresolutions.com Call us at: 727-475-1834

4. Understanding Basics of Understanding Basics of Polysomnography Polysomnography and Sleep Testing Billing and Sleep Testing Billing o Gastroesophageal reflux o Continuous blood pressure monitoring o Snoring o Body positions Documentation Requirements 1. All documentation must be maintained in the patient’s medical record and made available to the contractor upon request. 2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. 3. 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. 4. 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. 5. When billing for a sleep disorder test, the ordering physician’s NPI must be indicated on the claim form and the order kept on record. 6. Documentation must support that the accreditation, credentialing, and training requirements as stated in the LCD were met for the clinic, technologist, and physician. Email us at: kbradley@legionhealthcaresolutions.com Call us at: 727-475-1834

5. Understanding Basics of Understanding Basics of Polysomnography Polysomnography and Sleep Testing Billing and Sleep Testing Billing Applicable CPT Code Group 1 Codes 95782: Polysom <6 yrs 4/> paramtrs 95783: Polysom <6 yrs cpap/bilvl 95807: Sleep study attended 95808: Polysom any age 1-3> param 95810: Polysom 6/> yrs 4/> param Group 2 Codes 95811: Polysom 6/>yrs cpap 4/> 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 unatt&resp efft G0398: Home sleep test/type 2 porta G0399: Home sleep test/type 3 porta G0400: Home sleep test/type 4 porta Email us at: kbradley@legionhealthcaresolutions.com Call us at: 727-475-1834

6. Understanding Basics of Understanding Basics of Polysomnography Polysomnography and Sleep Testing Billing 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@legionhealthcaresolutions.com Email us at: kbradley@legionhealthcaresolutions.com Call us at: 727-475-1834

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