Neurology & Pain Management Coding Alert

Not all tests during sleep are alike, and an audit might be waiting. Sleep studies and polysomnography are not one and the same (see box on page 51). Distinguishing between them, and knowing what complaints or symptoms are covered by either a sleep study or polysomnography, will make all the difference if you encounter an audit. Realize Sleep Studies for Insomnia Are Not Covered The OIG wants to ensure physicians are not using sleep studies or polysomnography in response to noncovered complaints like insomnia, says Jill M. Young, CPC-ED, CPC-IM, president of Young Medical Consulting LLC in East Lansing, Mich. Medicare does not cover polysomnography (95808-95811, Polysomnography; sleep staging &) for diagnosis of patients with chronic insomnia because it considers it not reasonable and necessary under §1862(a)(1)(A) of the Act. Evidence at the present time is not convincing that polysomnography in a sleep disorder clinic for chronic insomnia provides definitive [...]