Sleep Studies

jazzyblues2005

Networker
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I've been coding sleep studies for awhile and have started second guessing myself. Depending on the insurance I've been using 95800-26 for home sleep studies, but am wondering if I should be using 95806-26. I'm using 95800 because the provider documents each measurement and the sleep time. I haven't found anything helpful so far.

Per Noridian MCR the facility should bill the G code w/POS 'Home' and the provider should bill 95806-26 w/POS 'Office'. Has anyone done this?

For 95810 and 95811 CPT states the patient is monitored "asleep" for 6 hours. If less than 6 hours mod 52 should be used. My provider documents the time the patient spends in bed and the time asleep. More times than not the patient is asleep for less than 6 hours. I've been using the time the patient sleeps in bed and am wondering if this is incorrect.

Any thoughts and/or resources would be helpful?

Thanks!
 

jazzyblues2005

Networker
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54
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0
Can someone explain to me the difference between 95800 and 95806? Besides what the CPT book says? I can't seem to understand when to bill 95806 as I've always billed the 95800 since my provider documents the sleep time. What I've found online is simply confusing me more. Thanks for any help.
 
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