Medicare Compliance & Reimbursement

Coding these procedures incorrectly could raise a red flag for auditors. Despite the similarities, there's a big difference between your physician conducting a "sleep study" versus a "polysomnography." Use this coding guide to ensure you report the codes your physician needs to get his due. Polysomnography and Sleep Studies Are Not Synonymous CPT currently includes these three codes for polysomnography: •95808 -- Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist. •95810 -- ... sleep staging with 4 or more additional parameters of sleep, attended by a technologist. •95811 -- ... 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. The CPT section guidelines for Sleep Testing Procedures lists the additional parameters of sleep referenced in these code descriptions as: 1) ECG; 2) airflow; 3) ventilation and respiratory effort; 4) gas exchange by oximetry, transcutaneous monitoring, or end tidal gas analysis; 5) extremity muscle activity, motor activity-movement; 6) extended EEG monitoring; 7) penile tumescence; 8) gastroesophageal reflux; 9) continuous blood pressure monitoring; 10) snoring; 11) body positions; etc. Tip from the field: A standard polysomnogram -- code 95810, for example -- makes limited use of EEG recording, and these diagnostic studies typically do not provide enough information for a physician to make a diagnosis, says Paul Zyglewski of Neurology Consults, P.C., in Smyrna, Tenn. A variety of neurologic disorders, including sleep-related epilepsy, may require a more in-depth EEG study. Polysomnography involves an over-night recording of data with the patient being monitored throughout the night. "A basic EEG can be done in an awake or asleep state, and monitors brainwaves," says Gabriela Gregory, MD, in Las Vegas. "It can be used to monitor the different characteristic patterns in an awake or asleep state as well as any activity caused by stimulation such as a strobe light or hyperventilation. The EEG is used in conjunction with a sleep study or polysomnography to define the different sleep stages, as well as monitor brain activity in those stages." Sleep Studies Do Have Separate Codes On the other hand, the following codes refer specifically to sleep studies: •95805 -- Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness. •95806 -- Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist. •95807 -- Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist. Term tip: The multiple sleep latency test (MSLT) and the maintenance of wakefulness test (MWT) are similar in that they both are measures of sleepiness during daytime hours. In [...]