Wiki 99211 for Home Sleep study

Create Wiki
H

hsmith67

Guru
Messages
151
Location
St Augustine, FL
Best answers
0
So we have a debate if we can/can't bill a 99211 for the visit when a patient comes in to get their home sleep study equipment. The nurse note:
All instructions clearly communicated and demonstrated to patient for home sleep study using the ARES.

Placing the ARES on after thoroughly washing and drying your forehead. Remove the plastic covers from the electrodes and the forehead sensor. Hold the cannula tips (2 prong extending from the clear plastic tubing) against the bottom of the ARES with your thumb and slide over your head.

Center the ARES over your nose and slightly above your eyebrows. Remove any hair from under sensors and electrodes make complete contact with your skin. Place the cannula tips inside your nostrils. Grasp the cannula with your hand and pull it away from the back of your head until it feels snug. Using your other hand, grab the slip tube and pull towards the back of your head until the tube rest snugly above the plastic portion of the strap. The cannula tips should be snug inside your nostrils. When properly tightened, the cannula cannot be pulled away from your nose.

In the morning: when you wake up, remove the ARES by gently peeling the back sensor away from your forehead prior to completely removing the ARES from your head. Failure to do so may damage the sensor connector. If the green light in front of the ARES is illuminated, switch the ARES off. If the light is no longer illuminated, the ARES has stopped recording. This is normal, and you do not need to turn the ARES off.

Return the ARES in plastic bag by 10 am the following morning to avoid late fee. Please let office know of any concerns.

Technical support: call 1-8xx-xxx-xxxx

Patient reported understanding proper instructions and educational book supplied with ARES for reference.

So, is this documentation sufficient for a 99211 and can bill the 95806 also or does the 95806 include the above and can't bill for 99211 separately?

Thanks,
Hunter Smith, CPC
 
I am new to coding sleep studies. Do you code the 95800 when they pick up the machine? What, if anything, do you code for when they return to the office to return the machine? The person at my work that I took this clinic over from told me that they were told to code 95800-TC when they pick up the machine and drop it back off, and 95800-26 when the provider does the interpretation report, but that does not seem right to me. Any guidance is appreciated.
 
Last edited:
MBackes2022 said:
I am new to coding sleep studies. Do you code the 95800 when they pick up the machine? What, if anything, do you code for when they return to the office to return the machine? The person at my work that I took this clinic over from told me that they were told to code 95800-TC when they pick up the machine and drop it back off, and 95800-26 when the provider does the interpretation report, but that does not seem right to me. Any guidance is appreciated.
Click to expand...
I definitely would not support billing 95800 when they pick up the machine as there are too many things that could go wrong that lead to this being seen as fraudulent (equipment didn't work, patient did not hook up correctly, patient had to go to ER for something unrelated, etc.). While I can understand the logic to bill the TC when the patient picks it up and then the 26 after interpretation I personally would prefer to have 1 claim/1 accounts receivable for the revenue cycle team to manage vs. 2 claims. If the issue is the provider is taking inordinately long to review/interpret then that is an issue that should be addressed as the provider is holding up payment for the global charge.
 
hsmith67 said:
I definitely would not support billing 95800 when they pick up the machine as there are too many things that could go wrong that lead to this being seen as fraudulent (equipment didn't work, patient did not hook up correctly, patient had to go to ER for something unrelated, etc.). While I can understand the logic to bill the TC when the patient picks it up and then the 26 after interpretation I personally would prefer to have 1 claim/1 accounts receivable for the revenue cycle team to manage vs. 2 claims. If the issue is the provider is taking inordinately long to review/interpret then that is an issue that should be addressed as the provider is holding up payment for the global charge.
Click to expand...
Thank you. I am looking for any information to back me up when I bring this to my supervisor's attention. It is a little different because it is at a military treatment facility, but I definitely do NOT agree with billing the code with the TC modifier twice, on pick up and drop off. The coder I took this over from also does not agree with the way that it has been coded, but for unknown reasons did not bring it up and just went along with it.
 
You must log in or register to reply here.
Top