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:
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.
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.
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:
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:
Simultaneous monitoring of heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement) during an unattended sleep study.
Simultaneous monitoring of minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone) during an unattended sleep study.
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 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.
To disclose strictly diagnostic polysomnography, use one of three codes:
- 95782 Sleep staging with four or five additional sleep parameters for children under the age of six, with a technologist present.
- 95808 Sleep staging with 1-3 additional sleep parameters for anyone of any age, supervised by a technologist
- 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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