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What code is appropriate?

  1. #1
    Default What code is appropriate?
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    We are sending patients to have home sleep studies. My physician only interprets the sleep study. What would be the appropriate code to use? We have been using 95800-26 but the physician had mentioned a G0399 code. We dont bill G codes ever and I fear these will not get processed. Any advice would be helpful.

    Also, it brings up the question of which place of service to use? Do we use a home POS since that is where the study was performed or do we use an office POS bc that is where the interpretation was read.

    Thank You.

  2. #2
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    Stuart Sailfish Chapter
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    867
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    Our practice opted out of ordering these, but here is a clip from the Medicare Processing Manual at may assist you.

    Sleep testing performed using an unattended portable monitor (home sleep testing (HST)) for the diagnosis of obstructive sleep apnea must adhere to the guidelines specified in "Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients" ( Journal of Clinical Sleep Medicine, Vol. 3, No. 7, 2007). If discrepancies exist between these guidelines and this LCD, the parameters in this LCD take precedence. HST is covered only for the diagnostic study of OSA and for no other indications.

    HCPCS codes G0398, G0399, and G0400 and CPT codes 95800, 95801 and 95806 (unattended sleep study) by definition involves the absence of a technologist. Unattended sleep studies must meet the narrative definition of the codes. G0400, Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels, must measure respiratory movement, airflow, and oxygen saturation. Effective for dates of service on or after 01/01/2011, CPT codes 95800 and 95801 have been added.
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    Director of Operations
    Ear, Nose and Throat Associates of South Florida, PA
    772-342-6976
    cfenildo@entsf.com


    "Nothing is stronger than the heart of a volunteer"

  3. #3
    Default
    Quote Originally Posted by Candyr73 View Post
    Our practice opted out of ordering these, but here is a clip from the Medicare Processing Manual at may assist you.

    .
    Thank you for this helpful information, Candy. May I ask why your office has opted out of ordering HST's?

  4. #4
    Location
    Stuart Sailfish Chapter
    Posts
    867
    Default
    Our Physicians did not feel that it was enough reimbursment for the trouble they had to go through to assure that the test was being perfomed accurately
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    Director of Operations
    Ear, Nose and Throat Associates of South Florida, PA
    772-342-6976
    cfenildo@entsf.com


    "Nothing is stronger than the heart of a volunteer"

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