Pulmonology Coding Alert
Report Sleep Study Codes Based on Tested Parameters
Question: Our physician, employed by a hospital that owns the practice, is interpreting sleep studies. For home sleep study interpretation, is it appropriate to code 95801-26? What else should I report?
Illinois Subscriber
Answer: Yes. You may use any one code from the codes 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort [e.g., thoracoabdominal movement]), 95800 (Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis [e.g., by airflow or peripheral arterial tone], and sleep time) and 95801 (Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis [e.g., by airflow or peripheral arterial tone], and sleep time) for a sleep study. Code choice depends upon the different components the provider is studying like heart rate, respiratory study, etc. You could also report either G0398 (Home sleep study test [HST] with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation) or G0399 (… minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation) if the criteria are met. Base the code choice on the number of channels used and component studied, as well as the preference by the payer.
You are correct in appending modifier 26 (Professional component) for the physician’s work of interpreting the test.
Pulmonology Coding Alert
- Pulmonary Rehab:
Ratchet Up Your Reimbursement for Rendered Pulmonary Rehab Services
Recording time spent per session is crucial to avoid bounce backs. You may think everything [...] - Modifiers News:
Make Way for Modifier 59 as an Exception Instead of Rule for Repeat Procedures
Take your payers into confidence before blindly following CMS’s directive to use modifiers 76 or [...] - ICD-10 Update:
Buck the Trend with Simplified Reporting of Sleep Apnea
Report other associated sleep conditions with additional ICD-10 codes. When your physician diagnoses sleep apnea, [...] - Reader Question:
Ascertain Location of Service for E/M Reporting
Question: Our pulmonologist was consulted to see a hospital patient who had Medicare. I billed 99213. [...] - Reader Question:
Report Sleep Study Codes Based on Tested Parameters
Question: Our physician, employed by a hospital that owns the practice, is interpreting sleep studies. For [...] - Reader Question:
Check Bundles Before Coding PFTs
Question: When done in office, can we charge for pre/post testing in addition to 6-minute walk? [...] - You Be the Coder:
31615 Covers Much More Than Simple Bronchoscopy
Question: Our physician performed a bronchoscopy on a ventilator dependent patient through an established tract. He [...]
