Good Coding Habits for Sleep Medicine Begin with Simplification
You can rest assured that when you break procedure
codes into groups, it’s easier to compare and apply proper codes.
Sleep medicine is a sub-specialty of neurology, which can seem very daunting to coders and physicians due to technicalities in the guidelines and procedure code descriptions. The good news is that code selection is simple when like codes are grouped together and compared by elements.
Procedure codes for sleep medicine are contained in CPT® code range 95803-95783 and HCPCS Level II code range G0398-G0399. These code sets can be categorized further by type: miscellaneous sleep diagnostic testing, home sleep study tests, sleep studies, and polysomnographies.
Miscellaneous Sleep Diagnostic Testing
There are two different, miscellaneous sleep diagnostic tests that can be performed.
The first test is:
95803 Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
For this test, patients are given an actigraph device to wear on the wrist in the home setting. The actigraph device records sleep and movements over three to 14 days. Once the device is returned to the provider’s office, the data can be downloaded to a computer and analyzed by specialized software to assist in the evaluation or monitoring of sleep disorders such as circadian rhythm disorders and sleep-disordered breathing.
The second test is:
95805 Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
Multiple sleep latency testing consists of four or five short nap opportunities in the office setting that are set a few hours apart. The patient’s brain waves, muscle activity, and eye movements are monitored and recorded during these nap sessions. That data can be used to diagnose narcolepsy and excessive daytime sleepiness, as well as assess the efficacy of treatments for breathing disorders. If fewer than four nap opportunities are recorded, append modifier 52 Reduced services.
Home Sleep Studies
Home sleep study tests cost less than in-office/hospital sleep studies because they are performed at the patient’s home. A special piece of equipment tracks breathing, oxygen levels, and breathing effort overnight. This data is abstracted from the device and is interpreted with specialized software to diagnose sleep disorders.
There are three HCPCS Level II codes to report home sleep study tests, with the differentiating factor being the number of channels used during recording:
Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels
CPT® code range 95806-95783 contains codes for all in-office/hospital sleep studies. These are either sleep studies or polysomnographies, which are specialized sleep studies.
Sleep Studies (Non-polysomnographic)
Non-polysomnographic sleep studies can be attended or unattended. There is only one code for an attended, non-polysomnographic sleep study:
Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
Three CPT® codes exist to report unattended, non-polysomnographic sleep studies:
Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)
Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time
minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone)
Code selection is based on what parameters were used during recording. If the total recording time is less than six hours, append modifier 52.
Polysomnographies are special types of in-office/hospital, attended sleep studies that record brain waves, blood oxygen levels, heart rate, breathing, eye movements, and leg movements. Polysomnographies can either be purely diagnostic, therapeutic, or “split.”
There are three codes to report a purely diagnostic polysomnography:
95808 Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist
age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
Code selection is based on the number of parameters used during recording and, for 95810 and 95782, the age of the patient. Append modifier 52 to 95808 and 95810 if the total recording time is less than six hours. Append modifier 52 to 95782 if the total recording time is less than seven hours.
Therapeutic and Split Polysomnography
Therapeutic polysomnographies are performed for patients with a diagnosis such as sleep apnea. The purpose of the test is to determine what titration levels of therapies, such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), are sufficient to treat the patient’s apnea.
Polysomnographies that are referred to as split are so called because a portion of the study is diagnostic, and if the patient is found to have sleep apnea during recording, CPAP or BiPAP titration is initiated to determine therapeutic levels for the patient.
There are two codes used to report therapeutic and split polysomnography, and code selection is based purely on the age of the patient:
95811 Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist
Append modifier 52 if the total recording time is less than six hours.
95783 Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist
Append modifier 52 if the total recording time is less than seven hours.
Patient: Jane Doe
During all-night polysomnography, the patient slept for 332 minutes out of 510 minutes in bed. Lights out occurred at 22:00 and lights on occurred at 06:30. Sleep latency was 128 minutes and REM latency was 116 minutes.
Respiratory monitoring using nasal/oral thermistor, pressure transducer, and respiratory inductance plethysmography belts revealed a respiratory disturbance index (RDI), apnea-hypopnea index (AHI), and central apnea index (CAI) of 0.0 events per hour of sleep. There were 0.0 respiratory events per hour of NREM and REM sleep.
During NREM sleep, the baseline SpO2 average range was 95-96%. During REM sleep, the baseline SpO2 average range was 95-97%. During the study, transcutaneous CO2 levels were observed to rise to 51-52 mm Hg.
The snoring microphone and technician observation revealed absent snores. EMG monitoring of the tibialis anterior muscle revealed 0.0 periodic leg movements per hour of sleep. EKG monitoring revealed a normal sinus rhythm.
Report this service using 95810 because it is a polysomnography with more than four parameters (respiration, oximetry, muscle activity, vital signs, and snoring), no titration was initiated, and the patient is older than 6 years old. Do not append modifier 52 because the total recording time was greater than six hours.
About the author:
Victoria Wheeler, CPC, CPPM, is the coding supervisor in the Department of Neurology at Washington University School of Medicine. She is a member of St. Louis East, Mo., local chapter.