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CPT 95800 home sleep study

  1. #1
    Default CPT 95800 home sleep study
    Medical Coding Books
    95800 Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time

    Does anyone know ANYTHING about this code? I am finding very little documentation on it. We are a billing service in Texas and we bill for a clinic in GA. They recently decided to start billing for this code but didn't get any information that is helpful to us in the billing company on how to actually bill. The office told me they are doing the GLOBAL part. I know that the TC should be POS 12 and the PC/26 mod should be POS 11 but what should the POS be if it is global? Do I bill it twice, 2 separate invoices?

    This particular scenario is the patient came in for preventative services and mentioned that he snored. The doctor did the service and then gave the device for the home study for the patient to take home. He now has the sleep study, CPT 95800, on the same invoice as the preventative, 99396, as well as labs with all as POS 11. I am thinking this may not be correct but the office has no idea. Can anyone shed any light on this code or have a link to a website that might? I tried Cahaba, the Medicare website for Georgia and there is really nothing there either.

    Gina Savarino, CPC

  2. #2
    Swainsboro/Statesboro, GA
    Default Confused as well!
    Hey Gina,

    I'm looking into this same issue, and I'm wondering why HCPCS codes G0398 - G0400 wouldn't be used instead of 95800, 95801 and 95806. I don't see a big difference in these codes.

    I did find some info on the Cahabagba website, such as all these codes require general physician supervision and have MD qualifications/proficiency requirements as well as technician qualifications. All codes are on the IDTF list (Independent Diagnostic Testing Facilities).

    There is a NDM issued March 2008 but this is more for the approval of home CPAP rather than the home study itself - I didn't find it very useful.

    Have you found out any additional info since your post??? I'd love to hear about it!
    Freda Brinson, CPC, COC, CEMC
    AAPC Swainsboro/Statesboro Chapter
    2017/2018 Secretary/Treasurer
    2016 Education Officer
    2014/2015 President
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)

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