Effective Coding Habits for Sleep Medicine June 2, 2021

Sleep medicine is a growing field that is very daunting to coders and physicians as it’s a subspecialty of neurology. It comes with highly complex technicalities in the guidelines and procedure code descriptions. Fortunately, code selection is simple when codes are grouped and compared by elements. Doctors, medical providers, and medical coders can be uncertain of how to code sleep studies and other services for patients with sleep disorders. This article will outline effective coding habits for sleep medicine practices to ensure the best reimbursement possible while providing accurate documentation in patient records. 

Different Types of Code Sets for Sleep Medicine.

The CPT® code range 95803-95783, as well as the HCPCS Level II code range G0398-G0399, comprise sleep medicine procedure codes. Miscellaneous sleep diagnostic testing, home sleep study tests, sleep studies, and polysomnography are the different types of code sets.

Miscellaneous Sleep Diagnostic Testing Codes

Two different types of sleep diagnostic tests can be used.

• 1st Test 

95805  –   Multiple sleep latency or wakefulness monitoring, recording, examination, and interpretation of physiological sleep measurements during multiple trials are used to determine sleepiness.

Multiple sleep latency monitoring consists of four or five brief naps arranged a few hours apart in the office environment. During these nap sessions, the patient’s brain waves, muscle function, and eye movements are all tracked and documented. This information can be used to identify narcolepsy and prolonged daytime sleepiness, as well as evaluate the effectiveness of breathing disorder therapies. Modifier 52 Reduced services should be added if there are less than four nap opportunities reported.

• 2nd Test

95803  – Testing, documenting, analyzing, interpreting, and reporting on actigraphy (minimum of 72 hours to 14 consecutive days of recording)

Patients should be given an actigraph device to put on their wrist in the home setting for this test. Over three to 14 days, the actigraph device records sleep and movement. When the unit is returned to the provider’s office, the data can be accessed to a computer and analyzed using advanced software to aid in the evaluation and monitoring of sleep disturbances including circadian rhythm disorders and sleep-disordered breathing.

Home Sleep Studies Codes

Since they are conducted at the patient’s home, home sleep studies are less expensive than in-office/hospital sleep studies. Overnight, a piece of special equipment monitors breathing, oxygen levels, and breathing effort. To diagnose sleep disorders, this data is extracted from the device and interpreted using specialized software.

There are three HCPCS Level II codes for documenting home sleep study studies, with the number of channels used during recording being the distinguishing factor:

1. G0400

Unattended home sleep test (HST) with type IV portable monitor; minimum of three channels Both in-office/hospital sleep studies are coded in the CPT® code range 95806-95783. These are either sleep studies or specialized polysomnography.

2. G0399

Unattended home sleep test (HST) with type III portable monitor; at least four channels: two respiratory movement/airflow, one ECG/heart rate, and one oxygen saturation.

3. G0398

Unattended home sleep study test (HST) with type II portable monitor; at least 7 channels: EEG, EOG, ECG/heart rate, EMG, airflow, respiratory effort, and oxygen saturation

Sleep Studies (Non-polysomnographic) Codes

Sleep studies that are not polysomnographic can be attended to or left unattended. An attended, non-polysomnographic sleep study has only one code which is:

• 95807

A technologist is present during the sleep analysis, which includes a simultaneous recording of breathing, respiratory effort, ECG or heart rate, and oxygen saturation.

The code is chosen based on the parameters used during the recording. Modifier 52 should be included if the total recording time is less than six hours. Three CPT codes exist to report unattended, non-polysomnographic sleep studies which are:

• 95806

Simultaneous monitoring of heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement) during an unattended sleep study.

• 95801

Simultaneous monitoring of minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone) during an unattended sleep study.

• 95800

Simultaneous monitoring of minimum heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time during an unattended sleep study.

Polysomnography Codes

Polysomnography is a form of sleep study that records brain waves, blood oxygen levels, heart rate, breathing, eye movements, and leg movements in an office or hospital setting. It may be used for diagnostic, therapeutic, or “split” purposes.

Diagnostic Polysomnography

To disclose strictly diagnostic polysomnography, use one of three codes:

1. 95782 Sleep staging with four or five additional sleep parameters for children under the age of six, with a technologist present.

2. 95808  Sleep staging with 1-3 additional sleep parameters for anyone of any age, supervised by a technologist

3. 95810 Sleep staging with four or five additional sleep parameters for children aged six and up, with a technologist present.

The number of parameters used during recording and, in the case of 95810 and 95782, the patient’s age are used to determine the code. If the total recording time is less than six hours, add modifiers 52 to 95808 and 95810. If the cumulative recording time is less than seven hours, add modifier 52 to 95782.

Therapeutic and Split Polysomnography Codes

For patients with a history of sleep apnea, therapeutic polysomnography is used. The test aims to figure out what titration levels of therapies like continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) are adequate for treating the patient’s apnea. On the other hand, split polysomnography is a part of the research that is diagnostic. If the patient is discovered to have sleep apnea during recording, CPAP or BiPAP titration is started to assess therapeutic levels for the patient.

Therapeutic and split polysomnography are reported using two codes, which are chosen solely based on the patient’s age:

95811   Sleep staging with 4 or more extra sleep parameters at the age of 6 years or older, with the initiation of continuous positive airway pressure therapy or bi-level ventilation under the supervision of a technologist.

If the total recording time is less than six hours, add modifier 52.

95783    Sleep staging with four or more additional sleep criteria, as well as the implementation of continuous positive airway pressure therapy or bi-level ventilation, with a technologist present. If the cumulative recording time is less than seven hours, add modifier 52.

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Podiatry Coding Tips to Improve Your Bottom Line April 16, 2021

People who have been dealing with medical coding for a long time know the frustrations of its complexity. A simple coding error can lead to increased claim rejection rates and decreased reimbursement rates. Doctors in Podiatric Medicine are not strangers to the intricacies of coding. They have to strictly use the appropriate modifiers, protocol codes, and patient diagnosis codes. Here are several tips that can help you avoid podiatry coding mistakes:

Review podiatry coding updates

The healthcare industry has undergone significant transformation in recent years, and podiatry is no exemption. Every year, there are coding improvements for all specialties, and coders must be aware of these changes to receive adequate compensation from payers. Furthermore, it has been noted that the podiatry coding standards have changed, and practices that are ignorant of these changes incur losses.

The Medicare Physician Fee Schedule requires billing and coding workers to be mindful of various fees and regulatory updates. Knowing these rules will help practices minimize the amount of paperwork they have to deal with when it comes to Medicare billing.

Use the correct modifiers

Correct modifiers allow for accurate payment of all podiatry procedures, including bunionectomy procedures. We highly recommend checking Correct Coding Initiative (CCI) edits, which can be found on the CMS website or in podiatry-related websites like the American Podiatric Medical Association (APMA) Coding Information Center.

When coding Evaluation and Management (E/M) modifiers, coders are often confused. The -24, -25 and -57 modifiers are three basic assessment and management (E/M) modifiers. For E/M programs, these modifiers must be used. Assert declination would occur if these modifiers are used for other utilities.

Specific E/M codes are paid rather than being combined for a single payment. If the E/M service is “important and separately identifiable” from the treatment a podiatrist is doing on the same day, use modifier 25. If medical attention was not needed, do not use this modifier.

 Be careful in “Unbundling” 

Unbundling, also known as fragmentation. refers to reducing the billing and base process of each component that can result in a higher payment than billing the entire comprehensive code. However,  take note that unbundling for the sake of obtaining a higher payment can be considered fraudulent billing.

Use the appropriate modifier to unbundle services properly

There are many legally unbundled cases. When two codes are performed at two different anatomical locations, they can be bundled together but are paid separately.

For example, billing for an arthroplasty code and a bunion code. If you’re not using any modifiers, group them. When performing these procedures on a lesser digit, using the right modifier would cause a bunion procedure as well as an arthroplasty procedure to be properly compensated. Another example is paying for several “single” procedures where there is a code for the same treatment that is classified as “multiple.”

Double-check for any downcoding

Another common blunder is downcoding. Upcoding entails paying for a higher quality of operation or different services than would normally be necessary. On the other hand, downcoding doesn’t have any useful purpose.

The idea is that if you obtain and bill a lower-level code (usually an E/M service), you’ll “go under the radar,” lowering your chances of being audited by insurance agencies. An insurance provider may be worried that, although you are costing the insurance company less money, your billing can still be considered fraudulent.

You could be cheating yourself out of legal money if you downcode. Changes in relative value units (RVUs), sequestration, and fines for not engaging in the Merit-Based Incentive Payment System (MIPS)/Medicare Access and CHIP Reauthorization Act (MACRA) scheme all appear to be eroding the reimbursements. Downcoding means you’re losing more money. Get paid for what you do and keep a copy of the chart note on hand to support your billing.

Tap Into Our Expertise on Podiatry Coding

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times with podiatry coding.

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How to Turn Your Revenue Cycle Management Process Around September 25, 2017

The efficiency of the your practice’s revenue cycle can have a critical impact on financial performance, and effective management of the cycle is of utmost importance to your practice. However revenue cycle management within health practices is becoming increasingly difficult, with greater administrative responsibilities and regulatory pressures. This article outlines the problems practices are facing and how to turn the revenue management process around.

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