Neurology & Pain Management Coding Alert

Question: We perform sleep studies in our sleep disorder center; the physicians perform and read all studies on site. Our Medicaid carrier denies our claims with 95810 and 95811, though the other payers reimburse without any problems. Am I billing correctly, or do I need to split bill or submit something different to Medicaid?Colorado SubscriberAnswer: When reporting polysomnography, select the appropriate code from 95808-95811 based on the staging and provider involvement:95808 -- Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist95810 -- ... sleep staging with 4 or more additional parameters of sleep, attended by a technologist95811 -- ... sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist.››Polysomnography codes have separate technical and professional components, but your question indicates that your staff performed the sleep study in a physician-owned sleep study center. If [...]