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Neurology & Pain Management Coding Alert

Reader Questions:

Sleep Studies Require Constant Attendance

Published on Sun Sep 19, 2004

Question: Must a technician provide constant attendance if we are to bill a complete sleep study?

Illinois Subscriber Answer: Yes, for Medicare and most third-party payers, a technologist must be present during the entire sleep study to receive payment.
 
For attended sleep study, choose 95807 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist). Insurers will normally deny payment for 95806 (Sleep study, ... unattended by a technologist) because CMS states that unattended sleep studies are generally performed outside of sleep-disorder clinics or hospital-affiliated facilities. As such, these procedures do not meet the requirements of medical necessary.
 
And most neurologists want information about the patient's sleep position that cannot be obtained unless a technologist is present during the entire study.
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