Neurology & Pain Management Coding Alert

Stick with attended studies to ensure payment If you-re reporting polysomnography (95808-95811), be sure the physician's documentation indicates that the patient's sleep was staged to distinguish the procedure from a standard sleep study (95807). Take a look at three sure-fire ways you can bolster your sleep testing and polysomnography coding success. 1. Call on 95805 for Wakefulness Testing You should claim 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness) if the neurologist orders a daytime test following polysomnography to measure sleepiness. The physician or technologist records the time it takes the patient to fall asleep during a course of four to five 20-minute nap opportunities. Clarification: During testing as described by 95805, the patient may not necessarily fall asleep. But this does not affect coding. Bonus tip: Don't leave your sleep study and polysomnography vulnerable to denials by not documenting where the tests occurred and who attended them, coding experts say. For instance, tests must take place -in an approved sleep center,- as defined by the Medicare Carriers Manual, section 2055. A sleep center may be directly affiliated with a hospital or a freestanding facility under a physician's direction. Time matters: All sleep studies must last a minimum of six hours, says Susan Turney, MD, FACP, medical director of reimbursement at the Marshfield Clinic in Marshfield, Wis. For tests of fewer than six hours, you must append modifier 52 (Reduced services) to the appropriate sleep study or polysomnography code. The payer will likely reduce payment for a truncated study. 2. Choose 95807 for Sleep Studies For a basic sleep study, which includes monitoring of respiratory effort and heart rate, you should use 95807 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist). Your physician should interpret and report the results and document the patient's positions while sleeping. Typically, neurologists order sleep studies to diagnose narcolepsy (347.xx), sleep apnea (780.5x or 327.2x) and parasomnia (which may include symptoms such as sleep walking, sleep terrors, and REM sleep behavior disorders), says William J. Conner, MD, a North Carolina physician. Unattended note: Medicare and many private payers dictate that sleep studies must be -professionally attended- to qualify for reimbursement. Because of this, some coders say you shouldn't bother to bill for unattended sleep study 95806 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist) with most carriers. Why this is: -According to the introduction in the CPT manual, just because there is a code for something doesn't make it reimbursable,- says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, [...]