Home Sleep Study

lapcpc

Networker
Messages
46
Location
Somersworth, NH
Best answers
0
We are billing home sleep studies to Medicare (NGS National Government Services) - and am trying to figure out what place of service that should be used. I have used office (physician reads the results and dictates a report in the office). Then have also used home as this is where the study actually took place. Both have been denied by Medicare. Is anyone else billing home sleep studies (procedure G0399 or 95800) to Medicare? Any help will be helpful.

Thanks, Lori
 

Candice_Fenildo

True Blue
Messages
867
Location
Port Saint Lucie, FL
Best answers
0
You can find more of this here http://www.aasmnet.org/codingfaq.aspx



The appropriate HCPCS code G0398, G0399, or G0399 is used when the unattended sleep study is done in the patient?s home. These codes reimburse for the work of instructing the patient in the use of the equipment. Do not apply a modifier when billing the G-code. When this service is billed, the place of service (POS) should indicate (12-Home). The date of service is the date the sleep study device was actually applied.

Report 95806-26 for the physician?s work of interpreting the test. When this service is billed, the POS should indicate (11-Office). The date of service is the date the sleep study is actually interpreted.

These 2 codes ? the appropriate G-code and CPT 95806-26 ? should never be billed for the same date of service.

CPT 95806-26 is payable only when used with one of the G-codes. Billing just the technical component of 95806 or the full global 95806 for unattended HSTs is not a payable service.
 

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
Messages
2,236
Location
South Berwick, ME
Best answers
1
I thought you were supposed to code the Place of service where the actual face to face took place....in other words, where the patient went to have the technician instruct them on how to use the equipment. I believe there's a Med Learn Matters article on this, specific to the reporting of the diagnostic interpretations. So if the patient was instructed on the hookup of the home sleep study at the outpatient pulmonary department, you'd use POS 22.
 

christinemaddux

Contributor
Messages
14
Location
Glendale, AZ
Best answers
0
Failed Sleep Study

What if the patient comes back with no data to report, can you still report the G code? If so, can you report it again when they redo the HST? Also, from the comments above with the 95806-26 billed on the date the report is written is that how you get around the G0399 being bundled with the 95806, because its technically billed on a different day?

We are having a lot of patients who seem to come back with no data :confused:
 
Last edited:

bduffie59

New
Messages
6
Best answers
0
Where are you specifically getting this information about the G codes are for being reimbursed for the work of instructing patients on the use of the equipment?

You can find more of this here http://www.aasmnet.org/codingfaq.aspx

The appropriate HCPCS code G0398, G0399, or G0399 is used when the unattended sleep study is done in the patient?s home. These codes reimburse for the work of instructing the patient in the use of the equipment. Do not apply a modifier when billing the G-code. When this service is billed, the place of service (POS) should indicate (12-Home). The date of service is the date the sleep study device was actually applied.

Report 95806-26 for the physician?s work of interpreting the test. When this service is billed, the POS should indicate (11-Office). The date of service is the date the sleep study is actually interpreted.

These 2 codes ? the appropriate G-code and CPT 95806-26 ? should never be billed for the same date of service.

CPT 95806-26 is payable only when used with one of the G-codes. Billing just the technical component of 95806 or the full global 95806 for unattended HSTs is not a payable service.
 
Top