Examine This Guide to Common Pulmonary Procedure Codes — Part 2
Learn how to report HSATs for Medicare patients. Pulmonary medicine encompasses a wide range of services, from basic diagnostic tests to advanced therapeutic procedures. This can present unique challenges for coders since pulmonary codes can cross into other sections of CPT®, including radiology, critical care, and surgery. Check out this final article of the series, where Revenue Cycle Insider examines the CPT® and HCPCS Level II codes for sleep studies and therapeutic services. Pick the Correct Pulmonary Therapeutic Services Codes Pulmonologists typically perform pulmonary therapeutic services in an outpatient or clinic setting to deliver inhaled medications and train patients in the proper use of respiratory devices. Assign the following codes to report these services: Coding tip: Documentation should indicate the medication or device, treatment or instruction time, and patient response. Refresh Your Understanding of Respiratory Therapy and Pulmonary Rehabilitation Codes The appropriate respiratory therapy or pulmonary rehabilitation services code depends on whether the service is for an individual or a group and the type of therapeutic procedure performed. These codes are Medicare-specific and used for documenting therapeutic exercises and breathing retraining performed during pulmonary rehabilitation programs: Coding tips: Confirm with payers whether to use CPT® or HCPCS Level II G codes, as some services or diagnoses might necessitate G codes based on payer policies. Also, remember that there are no direct CPT® crosswalks for the services listed above; Medicare requires these HCPCS Level II codes to distinguish pulmonary rehab services from general physical therapy procedures. Rest Assured Your Sleep Study and Polysomnography Coding Is Correct Sleep studies are diagnostic tests that measure breathing patterns, oxygen levels, heart rate, and sleep stages to evaluate disorders such as obstructive sleep apnea (OSA), insomnia, or hypoventilation. Correct code selection depends on the setting, parameters monitored, and payer requirements. Sleep lab or hospital sleep studies (attended): Sleep studies performed in a hospital or accredited sleep lab are attended overnight tests where a technologist monitors the patient’s sleep, breathing, oxygen, and heart activity in real time. These studies provide the most detailed assessment of sleep disorders and allow for immediate intervention, such as continuous positive airway pressure (CPAP) titration, when significant abnormalities are detected. Report these studies with one of the following codes: Coding tips: These studies must be attended by a qualified sleep technologist who continuously monitors and adjusts equipment when necessary. The codes can be billed global or broken out into technical- and professional-only components. Home sleep studies (unattended): Home sleep studies, or unattended home sleep apnea tests (HSATs), are performed in the patient’s home using portable equipment to record breathing, airflow, heart rate, and oxygen levels. These codes record fewer parameters than full-night polysomnography and are primarily used to diagnose OSA in patients without complex medical conditions. Codes 95800-95811 are used by commercial/private payers and some Medicaid programs: Note: Code 95801 is a simpler test of 95800 as sleep time is not recorded. In 2008, the Centers for Medicare & Medicaid Services (CMS) introduced G codes for HSAT due to the broad code descriptions for the above CPT® codes. The G codes are based on the number and type of physiological channels used to record data. Bill the following codes to Medicare for HSAT: Coding tips: The difference between 95800 and 95806 is that 95800 measures both sleep and respiratory parameters, while 95806 measures only respiratory effort and airflow without recording actual sleep time. Also, although 95800, 95801, and 95806 are unattended home sleep studies, there is still a technical component because of equipment and data processing. These codes can be broken down to technical and professional component billing. Lastly, remember to review payer policies to confirm billing compliance. Summary As you can see, pulmonary coding spans a wide range of diagnostic, therapeutic, and rehabilitative services. Correct code selection depends on the test type, level of supervision, and payer requirements. All services must be supported by a valid provider order and documented medical necessity. Always review applicable coverage policies, bundling edits, and relevant CMS national coverage determinations (NCDs) and local coverage determinations (LCDs) to ensure accurate and compliant billing. Series recap: Review the first article from the series, where Revenue Cycle Insider highlights commonly reported pulmonary CPT® codes for pulmonary function testing and stress tests. Dawnelle Sager, CPC, CPMA, CPC-I, CRC, Professional Fee Coding & Compliance Auditor,
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