Neurology & Pain Management Coding Alert

If you're frustrated with the payment you're receiving (or not receiving) for sleep studies and polysomnography, pay special attention to your diagnosis coding and documentation verifying place of service and the physician's attendance during testing. Failure to follow payers' strict guidelines for these services can lead to a nightmare of unpaid claims.
1. Know How the Procedures Differ
According to CPT, "Sleep studies and polysomnography refer to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review, interpretation and report." Although similar, sleep studies and polysomnography are separate diagnostic tests performed at different times to assess various physiological parameters of sleep, and you may report them separately if the patient's symptoms or diagnosis supports medical necessity, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.
 
CPT includes three primary codes to describe 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 ... attended by a technologist.
 
You may report 95805 for studies on asleep or awake patients. "The code [95805] applies to multiple sleep latency testing during periods of napping to assess sleepiness," as explained by the Coders' Desk Reference.
 
Code 95807 describes a standard sleep study. These studies are attended by a technologist and include monitoring of all parameters as specified in the code descriptor. A physician must interpret and report the results and generally documents the patient's position while sleeping. The physician may also use such studies to evaluate a patient's response to therapy such as nasal continuous positive airway pressure (NCPAP).
 
Note: Most insurers, including Medicare, will not reimburse an unattended sleep study, 95806 (see below).

2. Include Sleep Staging in Polysomnography
According to CPT, polysomnography differs from sleep studies by the inclusion of sleep staging, which is defined to include a one- to four-lead electroencephalogram (EEG), an electrooculogram (EOG) and a submental electromyogram (EMG), says Susan Turney, MD, FACP, medical director of reimbursement at the Marshfield Clinic in Marshfield, Wis. In addition, polysomnography involves overnight recording of data, and the physician (or technologist) monitors the patient throughout the night.
 
CPT also specifies 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 [...]