Pulmonology Coding Alert

Question: My pulmonologist performed only the interpretation component of a split-night polysomnogram. I billed it as 95810-53-26 and 95811-59-26, but the carrier denied the claim. What did I do wrong? Answer: You should have billed only 95811 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist) -- the more extensive service. This service includes the diagnostic sleep study (95810, ... sleep staging with 4 or more additional parameters of sleep, attended by a technologist), along with continuous positive airway pressure (CPAP) therapy titration to the study. Rationale: Since CCI has bundled 95810 into 95811, coding rules dictate that you should never report them together. In fact, 95808-95811 are part of the same code family, so you only use them one at a time. Appending modifier 26 (Professional component) is appropriate to indicate the pulmonologist [...]