Dont Sleep on Your Polysomnography Coding
Published on Tue Apr 01, 2003
If you're waking up tired from long days trying to squeeze reimbursement for your polysomnography studies, then you need to make sure you learn how to correctly bill polysomnograms for each different sleep disorder. Polysomnography is a sleep study that records many body functions including the brain's electrical activity, eye movement, muscle activity, heart rate, respiratory effort, airflow, and blood oxygen levels. Melanie Caddy, chief technician, Greater Pittsburgh Sleep Center, says that most polysomnography studies consist of about 16 channels and are used to diagnose several sleep disorders. Polysomnography (95808-95811) differs from a sleep study in that it includes sleep staging. According to Sally Gallagher, RPSGT, director of clinical services, Sleep Care, in Cherry Hill, N.J., industry standards dictate that certain measurements be taken during a nocturnal polysomnogram, including EEG, EOG, EMG (chin and leg), ECG, respiratory flow, respiratory effort, and gas exchange by oximetry. Several other parameters may be tested:
Extremity muscle activity, motor activity
Extended EEG monitoring
Penile tumescence
Gastroesophageal reflux
Snoring
Body positions In order for you to report polysomnography, sleep must be both recorded and staged. Also, you must measure parameters for six hours or more with physician review, interpretation and report. If polysomnography lasts less than six hours, you should report the code with modifier -52 (Reduced services). There are three polysomnography codes, which you use differently depending on the number of parameters tested and any other tests done.
The base polysomnography code (95808) includes the measurement of one to three parameters, while a technologist must attend the study. There are two other relevant codes: 95810 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist) and 95811 (... sleep staging with 4 or more parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist). Medicare covers these polysomnography services only when they are performed on patients with narcolepsy, sleep apnea, impotence or parasomnia.
Usually a technician performs the studies, while the physician supervises and interprets the results. You should bill globally (95808) when the pulmonologist performs the study in his own sleep laboratory. Otherwise, you should bill for the professional component (95808-26) when an outside laboratory performs the tests, says Martin Cohn, MD, Sleep Disorders Center of SW Florida, in Naples. Coding for Narcoleptic Patients Narcolepsy (347) is a neurologic disorder with symptoms that include abnormalities of REM, excessive daytime sleepiness, and sometimes sleep paralysis or hypnogogic hallucinations. According to Caddy, the test used to confirm this disorder includes an overnight sleep study followed by a multiple sleep latency test (MSLT). Usually at least three electrophysical channel tests are given an EEG, EOG and EMG. The MSLT is a "nap opportunity" test [...]
