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Sleep Studies

  1. #1
    Default Sleep Studies
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    I work for a Sleep Disorder Center and we perform the studies and read them all in the same office by the same doctors. I'm billing 95810 and 95811. We get paid okay by all payors except for Colorado Medicaid and because of this I'm being questioned on how I'm coding. The people in my office who know nothing about coding seem to think the we can split bill it, like bill a facility fee in addition to the study fee. Is this correct? Is there any website or something that you can direct me to so that I can prove that billing a 95810/95811 is the correct way to bill this?
    Thanks
    Brittany Purcell, CPC

  2. Default sleep study split??
    along these same lines, We interp sleep studies. I bill for 95810 and the 95811. not at the same time. One of the drs told me that he heard that if they do a diagnostic (95810 ) for a few hours and then switch over to a cpap /bipap that we can bill both codes. the first one on say 9/12 95810 and the second 95811 say on 9/13. I told him that I searched and I believe that like any diagnostic 95810 is included in 95811 when changes over. the cpt book says 95811 initiation of continuous positive airway pressure therapy etc.

    also 95811 is split study which I think my dr is decribing.

    Am I correct in billing a 95811. its one code per night.

    Thanks


    Donna J Weber CPC

  3. #3
    Default
    You should not be billing both 95810 and 95811 on the same night. 95810 is diagnostic only. 95811 is split night which includes the diagnostic portion.
    If you are performing the study and the interpretation you would bill the GLOBAL code which is the 95810 or 95811 which reimburses for the both the technical(facility) and professional(dr interpretation) components. Most Medicaid programs do reimburse less than other plans.

    Kim Boyd, CPC

  4. #4
    Default
    Quote Originally Posted by Donna View Post
    along these same lines, We interp sleep studies. I bill for 95810 and the 95811. not at the same time. One of the drs told me that he heard that if they do a diagnostic (95810 ) for a few hours and then switch over to a cpap /bipap that we can bill both codes. the first one on say 9/12 95810 and the second 95811 say on 9/13. I told him that I searched and I believe that like any diagnostic 95810 is included in 95811 when changes over. the cpt book says 95811 initiation of continuous positive airway pressure therapy etc.

    also 95811 is split study which I think my dr is decribing.

    Am I correct in billing a 95811. its one code per night.

    Thanks


    Donna J Weber CPC
    If you do a diagnostic study 95810 on 9/12 but for whatever reason are not able to switch over and put the patient on a CPAP or BIPAP machine the same night and you then have the patient come back the next night, few nights later, even weeks later, to do titration, you would bill the 95810 for the first night and then 95811 on the next visit, but you would not bill them both on the same night.

    Kim Boyd, CPC

  5. Default
    Kim



    Thank you so much for your speedy reply. I was sure that I was correct. Sometimes you tend to doubt yourself. I wanted to make sure that I was correct because I knew I had to take a stand on this.


    Have a great weekend

    Donna J Vitone Weber CPC CMA

  6. Default Sleep Studies and Clinical Psychologists
    Does anyone have Clinical Psychologists who are Board certified in Sleep medicine? If so, are they interpreting the sleep studies, 95810-26, 95811-26 and billing under their own name or the MD? Are there any concerns with the Clinical Psychologists working outside their Scope of Practice, thank you

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