Pulmonology Coding Alert

Stick with attended sleep studies to ensure paymentYou can bolster your polysomnography and sleep testing coding success if you follow three sure-fire ways to success.Be careful: Before reporting polysomnography (95808-95811), be sure your physician's documentation indicates that the patient's sleep study was staged to distinguish it from a standard sleep study (95807).How Sleep Studies Fit for PulmonologistsSleep studies are on the rise for pulmonologists as a way to confirm the extent of a patient's sleep apnea, or even to document that the patient doesn't have the condition -- which is why you need to be in the know for coding the procedures."In Wisconsin, we have a large trucking firm that uses sleep studies to confirm that there is not a sleep apnea problem," says Cheryl Klarkowski, RHIT, CPC, a coding specialist with BayCare Clinic. "They don't want their drivers falling asleep while driving."Patients might also have a sleep study because other health issues manifest from underlying pulmonary issues. For example, Klarkowski says the origin for shortness of breath (SOB) can shift from being a cardiology problem to a pulmonary problem. The physician might test the patient for sleep apnea after diagnosing pulmonary hypertension (HTN) while investigating the cause of SOB."It's like a chain reaction," Klarkowski explains. "The sleep apnea causes your heart to work harder, which causes your heart to become more muscular, which can lead to heart problems."1. Code 95805 for Wakefulness TestingYou should claim 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness) if the physician orders a daytime test following polysomnography to measure sleepiness, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver.The physician or technologist records the time it takes the patient to fall asleep during a course of four to five 20-minute nap opportunities provided during the testing period in the sleep lab.Clarification: During testing as described by 95805, the patient may not necessarily fall asleep, but this does not affect coding.Bonus tip: Don't leave your sleep study and polysomnography vulnerable to denials by not documenting where the tests occurred and who attended them, coding experts say.For instance, tests must take place "in an approved sleep center," as defined by the Medicare Carriers Manual, section 2055. A sleep center may be directly affiliated with either a hospital or a freestanding facility under a physician's direction.Time matters: All sleep studies must last a minimum of six hours, says Susan Turney, MD, FACP, medical director of reimbursement at the Marshfield Clinic in Marshfield, Wis.For tests of fewer than six hours, you must append modifier 52 (Reduced services) to the appropriate sleep study or polysomnography code. The payer will [...]