Code for Reading/Intr Sleep Study

Rip

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I'm a bit confused on what code to use when the physician only does the read/review/interpretation of the sleep study.
Would the code be 95811-26 or 95810-26 for facility based?
What if the read is from a portable home monitor?
 
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Hope this helps (need to verify - from 2011 CPT):

95803 - actigraphy testing, recording, analysis, interpretation, and report (min 72 hrs to 14 consecutive days of recording)

95805 - multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness

95806 - sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)

(for unattended sleep study that measures heart rate, oxygen saturation, respiratory analysis, and sleep time, use 95800)
(for unattended sleep study that measures heart rate, oxygen saturation, and respiratory analysis, use 95801)

95800 - sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time

95801 - minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone)

95807 - sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by tech

95808 - polysomnograph; sleep staging with 1-3 additional parameters of sleep, attended by tech

95810 - sleep staging with 4 or more additional parameters of sleep, attended by tech

95811 - sleep staging with 2 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by tech

:cool:
 

Rip

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The physician is only reading and interpreting the results.
The sleep stuidy is not done in our clinic.
In the past his services were billed by the facility were study was preformed, but
now physician want to bill his service through the clinic.

so would I use a 26 modifier to the above procedures codes?
 

lisamarhea

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Yes, you would use a modifier 26 if you're only billing out the interpretation.
As far as which code to pick, I would call the facilty to determine what type of equiment they're using for the testing just to make sure you're billing it correctly. We either bill out 95810 (basic PSG) or 95811 (PSG with CPAP machine used during study).
Hope that helps!
 

mburke81

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Our Physicians just started billing for interps on sleep studies done at the sleep lab. However Medicare denied stating type of service inconsistant with place of service. What are they wanting? I put location at OP because thats where the studies was, should I of used the office as location?
 
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