Wiki Sleep Medicine Billing- Split night

[myriamgaribay]

Hello,

Is anyone experiencing issues with sleep medicine billing when a split-night study (95811) is ordered but does not meet split-night criteria? Many insurance companies are denying these claims and refusing to allow a downcode to a diagnostic study (95810).

How are billers addressing this issue? Any insights or successful appeal strategies would be greatly appreciated.

 

[catherinetinkey@entmedicalservices.org]

When potentially doing a split night you can do two things, get a prior authorization for both 95810 & 95811. If they don't meet criteria you can bill the 95810. If the patient met the criteria for CPAP but you didn't have enough time to qualify that portion of the study have them come back for that part but you can only bill 1 95811. 95811 can be done on multiple nights but you can only bill for one study. In lab is the gold standard for sleep issues but insurance companies are pushing patients to have home studies which really doesn't give full sleep information. There are a lot more sleep issues than just OSA that can affect a patient's overall health.