Question how would we charge 2 nights home sleep studies 95800-26 reports lists time for 1st night and time of 2 night

[ermastiles]

Physician charging 2night home sleep study, 1 report do we charge the signed date like 95800-26.95800-26-59 or 76 are do we charge dos 95800-26 first date 95800-26 2 date ?

 

[CBLENNIE]

There are a few questions about this question:

• First question: does the payer you are submitting these claims to accept 95800 for unattended HST, or do they require one of the HCPCS created specifically for HSTs G0398-G0400?
• Also, most payers are requiring PAs for sleep testing, so have you checked with the payer you are planning on submitting this claim to if a PA is required, and if so you will need to try to get a PA for the 2 nights?
• If they do accept 95800 for an unattended HST, how many hours are being recorded each night? Per the notes for 95800 if the recording is for less than 6 hours you need to append modifier 52.
• What is the medical necessity of the unattended HST being done over 2 separate nights? The NCD 240.4.1 Sleep Testing for OSA, indicates that a 2 night supervised PSG in a sleep lab is recommended by the American Thoracic Society and the American Academy of Sleep Medicine have for the diagnosis of OSA and the initiation of continuous positive airway pressure (CPAP). I found nothing in the NCD, or the LCD for the Texas Part B MAC Novitas LCD L35050 Outpatient Sleep Studies does not mention multiple night studies.

If the payer accepts 95800 for an unattended HST and you are billing for 2 nights, I believe you would bill for 2 separate procedures for each night/DOS and there should be a report for each study/night and if either night/study is less than 6 hours recorded remember to add modifier 52 per the CPT guidelines.

Just a few thoughts from an insurance company compliance specialist and coder...