Six CPT® Changes Reflect the Latest in Sleep Medicine
By I. A. Barot, MD
For 2011, there are six CPT® code changes in the field of neurology/sleep medicine. The additions are primarily the result of the home sleep testing (HST) or portable monitoring (PM), which recently have emerged as a potential lower-cost pathway to screening at-risk patients for sleep-disordered breathing (SBD), including mainly obstructive sleep apnea syndrome (OSAS).
95800 and 95801
Patients with sleep complaints who do not include sleep-related breathing disorders may not be screened with HST/PM (95800 Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time and 95801 Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone). Even a highly sensitive or accurate portable sleep study fails to detect much beyond obstructive events (apneas, hypopneas). Many HST units are poorly sensitive and may result in false negatives.
A proper protocol for HST would include screening in high-risk sleep apnea patients (snoring, witnessed apneas, daytime sleepiness, etc.), with the intention of treating these patients promptly using auto-titrating nasal continuous positive airway pressure (CPAP) therapy and avoiding excessive testing, if possible. Following such a protocol not only could screen effectively many more patients for OSAS, but also could reduce the health care burden substantially as over 80 percent of SBD patients suffer from non-complicated OSAS. This proactive approach is likely to lower significantly the disease burden of hypertension, cardiac issues, diabetes, obesity, mood disorders, cognitive complaints, and attention deficit hyperactivity disorder (ADD/ADHD), among other commonly-treated conditions (for more information on the link between sleep disorders and other conditions, see “Sleep Apnea: The Not-So-Silent Bed Partner,” August 2010 Coding Edge, pages 26-27).
95810 and 95811
For those patients who either have 1) a negative or inconclusive HST with a high pre-test probability of OSAS, or 2) a higher pre-test probability for either severe or complex sleep apnea, there should be a lowered threshold for a more thorough evaluation, including in-lab polysomnography with proper titration (95810 Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist and 95811 Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist).
95953 and 95956
Two CPT® codes have been revised for 2011, and include prolonged seizure monitoring. The first of these, 95953 Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended, includes ambulatory recordings that are billed in 24-hour increments depending upon the length of recorded electrocortical activity. Typically, electrodes and sensors are attached to a patient in a neurophysiology lab, data is recorded passively for 24 hours, the patient presses a button if he or she feels an “event” (e.g. possible seizure), and the data is downloaded on a hard drive every 24 hours.
The second prolonged seizure monitor (95956 Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technologist or nurse) typically takes place either in an epilepsy monitoring unit (EMU) or in a neurologist’s office. Here, the patient is attached to EEG equipment, is observed for 8-24 hours, and the data typically is recorded with both video and EEG interpretation available because this test commonly is done to identify non-epileptic seizures (pseudoseizures), or to localize seizures for potential epilepsy surgery.