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Coding an incomplete cpap titration 95811

  1. Default Coding an incomplete cpap titration 95811
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    Does anyone know how to code a cpap titration (95811) when the patient was unable to sleep? The test continued for over 6 hours. Medicare requires that the patient sleep at least 2 hours. The patient wants to return and try again.

    My thoughts are either a modifier 52 for reduced services or tc for tech time.


  2. #2
    I would append a modifier 52 to the claim (are you billing for both the report and tech time? - if so put a modifier 52 on the claim.

  3. Default Two modifiers?
    Since the test did not complete, there will be no report. The test will be redone. In addition to modifier 52, maybe I should also code with modifier TC for the tech time?

  4. #4
    I'm not sure what Medicare carrier you deal with, but Highmark will usually request records on a sleep study w/ a 52 modifier. Our experience has been that if there isn't enough data to produce a report they won't pay, even a reduced amount. A TC would probably be your best bet, but if you want to utilize the 52 or 52:TC you are probably going to have to file an appeal.

    Good Luck!

  5. Default HELP PLS. sleep studies
    We want to have a sleep study clinic here in our office/I know nothing regarding sleep studies. My physician asked me "how much does MC reimburse for a CPAP machine?" I have no clue, I dont even know where to start. Do we buy our own to do the testing and bill for the testing? Not the actual machine? I need HELP

  6. Default HELP PLS. sleep studies
    Medical Billing
    email me at my login name but please titile it accordingly so I can recognize it

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