Neurology & Pain Management Coding Alert

Sleep apnea commonly is diagnosed using sleep studies. But getting reimbursed for these studies can be challenging. By using the appropriate procedure and diagnosis codes, however, neurologists can ensure that insurance carriers will not deny claims for such testing.

In recent years, there has been a growing recognition of the significance of sleep disorders and the grave impact these conditions have on a patients overall health. Among the most prevalent of these disorders is sleep apnea, which is a respiratory dysfunction resulting in the cessation or near cessation of respiration for 10 seconds or longer.

In reponse, many neurology practices are operating sleep centers that provide testing for sleep apnea. The testing takes several forms, and neurology coding professionals who understand the various studies and their appli-cations are better able to assign the most applicable codes.

Once the sleep test has been completed, the neurologist interprets the results. The interpretation, however, is bundled into the code for the study.

Coding the Primary Testing Procedure

According to Medicare, the most common nocturnal (during sleep) symptoms for these conditions include snoring, abnormal motor activity (flailing or getting out of bed) and nocturia (urinating at night). Diurnal (during wakefulness) symptoms associated with sleep apnea involve excessive daytime sleepiness, poor memory and personality changes.

Paul Blackman, BS, RPSGT, RCP, CPFT, chief technologist at the Atlanta Center for Sleep Disorders, says most patients are referred to his facility because they suffer from sleep disorders of unknown origins. They may be snoring excessively, waking up tired or sleep-walking. Most of these patients have seen their primary- care physician and have been referred to a neurologist for these problems.

The initial study to determine the cause of the disorder, he says is polysomnography95810 (polysomnography; sleep staging with four or more additional parameters of sleep, attended by a technologist).

Polysomnography is an all-night study that should be used if more than five observed apneas or hypopneas occur during each hour of sleep for at least six hours of nocturnal sleep.

This study bundles in a number of monitoring activities that allow us to identify neurological conditions that may be interfering with sleep, Blackman says, adding that polysomnography (or PSG) is defined to include a one-to-four lead electroencephalogram (EEG), an electrooculogram (EOG) and a submental electromyogram (EMG).

Additional parameters of sleep measured during a polysomnography also may include electrocardiogram (ECG); airflow, ventilation and respiratory effort; gas exchange by oximetry, transcutaneous monitoring or end tidal gas analysis; extremity muscle activity, motor activity-movement; extended EEG monitoring; penile tumescences; gastroesophageal reflux; continuous blood pressure monitoring; snoring; and body positions.

PSG, Blackman says, generally is conducted on adults and children older than one year. Infants, whose sleep disorders are less likely [...]