Wiki Coding an incomplete cpap titration 95811

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SantaRosa27

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Does anyone know how to code a cpap titration (95811) when the patient was unable to sleep? The test continued for over 6 hours. Medicare requires that the patient sleep at least 2 hours. The patient wants to return and try again.

My thoughts are either a modifier 52 for reduced services or tc for tech time.

Thanks.
 
I would append a modifier 52 to the claim (are you billing for both the report and tech time? - if so put a modifier 52 on the claim.
 
Two modifiers?

Since the test did not complete, there will be no report. The test will be redone. In addition to modifier 52, maybe I should also code with modifier TC for the tech time?
 
I'm not sure what Medicare carrier you deal with, but Highmark will usually request records on a sleep study w/ a 52 modifier. Our experience has been that if there isn't enough data to produce a report they won't pay, even a reduced amount. A TC would probably be your best bet, but if you want to utilize the 52 or 52:TC you are probably going to have to file an appeal.

Good Luck!
 
HELP PLS. sleep studies

We want to have a sleep study clinic here in our office/I know nothing regarding sleep studies. My physician asked me "how much does MC reimburse for a CPAP machine?" I have no clue, I dont even know where to start. Do we buy our own to do the testing and bill for the testing? Not the actual machine? I need HELP
 
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