Neurology & Pain Management Coding Alert

Question: A patient covered by Medicare has a chief complaint of insomnia. Our neurologist wanted to know if diagnostic polysomnography is covered for this condition. Washington Subscriber Answer: Unfortunately, Medicare doesn't consider insomnia to be one of the covered conditions. Per Chapter 15 in the Medicare Benefit Policy Manual, "The use of polysomnography for diagnosis of patients with chronic insomnia is not covered under Medicare because it is not reasonable and necessary under §1862(a)(1)(A) of the Act." The medical conditions for which polysomnography testing is covered are: narcolepsy, sleep apnea, impotence, and parasomnias, such as sleepwalking, sleep terrors, and rapid eye movement (REM) sleep behavior disorders. Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. Insomnia can be classified as to how long it lasts and how often it occurs. Acute insomnia can last from one night to a few weeks, whereas chronic insomnia is [...]