Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that the neurologist conducted a level-four E/M service for an established patient with psychophysiologic insomnia, and then attached a leg band for an actigraphy. Seven days later, the patient returned the actigraphy band. I’ve never coded for an actigraphy. How should I report this scenario, and what exactly is an actigraphy?

Oklahoma Subscriber

Answer: On the claim, you should report 95803 (Actigraphy testing, recording, analysis, interpretation, and report [minimum of 72 hours to 14 consecutive days of recording]) for the actigraphy. Then, report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity…) for the E/M service.

No modifier 25? The Correct Coding Initiative (CCI) edits do not bundle 99214 into 95803, so there’s no need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99214.

ICD-10 alert: Remember to append F51.04 (Psychophysiologic insomnia) to 95803 and 99214 to support medical necessity for the office visit and the diagnostic study.

Background: Actigraphy is a noninvasive recording of gross motor movements, typically done via an ankle or wrist bracelet that monitors the patient’s rest and activity cycles through the course of several days. In addition to insomnia, your provider might use actigraphy monitoring to evaluate and diagnose circadian rhythm sleep disorders, excessive sleepiness, and periodic limb movement syndrome.

You should code 95803 for studies that last between three and 14 days.

Bundle alert: According to the Correct Coding Initiative (CCI), you should not report 95803 in conjunction with 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoracoabdominal movement) through 95811 (Polysomnography; agºe 6 years or older, 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).

In addition, the NCCI edits bundle the 95803 into these diagnostic sleep studies and do not allow a modifier to be used to bypass the bundling edits.