Primary care physicians can often manage many sleep disorders. However, when unusual sleep patterns require further investigation, expert opinion and sleep studies may be necessary.
Polysomnography (PSG) means keeping an eye on and recording different things happening during sleep in a special sleep lab. These studies are supervised by an expert during sleep, allowing for intervention if needed.
Polysomnography and Sleep Study Coding
Below are some commonly used CPT codes for Polysomnography and Sleep Testing. Also, you need to remember to consult payer-specific reimbursement guidelines for precise coverage details.
- For non-attended sleep studies use the CPT/HCPCS code that best describes the service.
- For split night studies, bill CPT code 95811 alone, as it includes CPT code 95810. (Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist)
- To report a study as polysomnography (PSG), sleep must be recorded and staged and directly attended by a qualified technologist. Use modifier 52 if the recording is less than 6 hours or for other cases of reduced services.
- CPT codes 95782, 95783, 95808, 95810, and 95811 include sleep staging. Medicare does not expect separate billings for EEG, EOG, and/or EMG in addition to these codes.
Now, it's time to know about the various documentation requirements for sleep study billing:
- Keep all paperwork in the patient's file and share it with the contractor if they ask.
- The medical record you send should match the ICD-11 code you chose. And the CPT/HCPCS code should describe the service done.
- Make sure every page of the record is clear and has the patient's name and dates of service. Also, the documentation needs to have the clear signature of the doctor or the person taking care of the patient.
- You need a doctor's order to get diagnostic tests, as per the regulations in CFR, Title 42, Volume 2, Chapter IV, Part 410.21 (a).
- When you bill for a sleep disorder test, make sure to include the ordering doctor's NPI on the claim form, and keep the order on file.
Sleep doctors use Evaluation and Management (E/M) codes for office visits. These codes are only for doctors and some advanced nurse practitioners like NPs and PAs. Technologists can't bill on their own, but they can bill under the supervision of a doctor if specific rules are followed.
As you might have already realized sleep study billing is a cumbersome job, therefore, it is always advisable to outsource it to a reputed revenue cycle management company.
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