Pulmonology Coding Alert

Question: We've recently started billing sleep studies for a pulmonology practice. What Medicare or CPT requirements must we meet to report a polysomnography code (95808-95811)? In addition, how does polysomno-graphy differ from sleep studies?

Florida Subscriber

Answer: Medicare and private insurers require your pulmonologist to both record and stage a patient's sleep to report polysomnography codes (95808-95811). 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). You can choose from three polysomnography codes, which you use differently depending on the number of parameters tested and any other tests done.
 
Typically, your physician supervises while a technician performs the base polysomnography service (95808, ... sleep staging with 1-3 additional parameters of sleep, attended by a technologist).
 
When the pulmonologist performs the testing in his or her laboratory, you may report the global 95808. But if the tests occur at an outside lab, attach modifier -26 (Professional component) to the code, which indicates that your physician only interpreted the results.
 
You should assign 95810 (... with 4 or more additional parameters of sleep, attended by a technologist) and 95811 (... with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist) only when your physician orders them for patients with narcolepsy, sleep apnea, impotence or parasomnia.
 
Physicians stage polysomnography studies, but not  sleep studies (95805-95807). Polysomnography includes a one- to four-lead electroencephalogram (EEG), electroculogram (EOG), and submental electromyogram (EMG).