# sleep studies



## manda12 (Mar 5, 2013)

Hello all,

at my cardiology office i work at..we do bill some sleep studies. Our physician is coming to us asking if its true that the patients have to sleep for a total of 6 hours to bill for the complete code? i cant find it anywhere stating that..does anyone else hear this or know where i can get this information for my physician? thanks


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## Pam Brooks (Mar 5, 2013)

Yes, it's in the 2013 CPT professional edition, under polysomnography, in the instructive text on page 532 (if you have the official AMA version).  It states a period of at least 6 hours.


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## manda12 (Mar 5, 2013)

ok great thank you so much. i appreciate your help.


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## pccBiller (Mar 5, 2013)

I would look at that descriptive text more carefully.  It states "a sleep test involving the continuous, simultaneous, recording of physiological parameters for a periof of at least 6 hours..."

It also directs you in the second paragraph of text to use a modifier 52 if there are less than 6 hours of recording.

I was originally taught that the patient had to sleep for six hours, but was instructed at a sleep conference hosted by the American Academy of Chest Physicians that it only had to be six hours of *recording.*

Many sleep patients do not acheive six hours of sleep, especially when they have so many arousals due to their apnea.


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## manda12 (Mar 6, 2013)

ok that makes sense. thanks for your help.


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## lisa2010 (Mar 12, 2013)

*sleep study when pt is not a sleep ! Good Article!*

I recently accepted a job billing & coding for Polysomnography. I was doing some research and found this article. I found it to be very informative. Hope it helps.

I interpreted this article to say is a sleep study is not gaged by the amount of sleep but the dx testing done. Which makes sense because the dx could be insomnia and in which case would be testing for the dx for lack of the ability to reach any of the 4 levels of sleep. 

Thanks Lisa 


Your Top-3 Polysomnography Questions Answered



Refresh your expertise with our 95808-95811 primer 

Before you report staged sleep studies (polysomnography), look for documentation details on how long the physician observed the patient, what parameters the physician measured, and how long the patient was asleep. Failing to note these details on the extent of the polysomnography could reduce your pay.

Take a look at these three frequently asked questions to determine whether you know how to select the most appropriate polysomnography code and any modifiers that may apply.

Question 1: Should I still report 95811 if the physician observes a patient for six hours when the patient is not asleep for the full six hours? 

If the physician made an official diagnosis based on the study (that is, 780.53, Sleep disturbances; hypersomnia with sleep apnea), you should report one of the polysomnography codes (95808-95811), depending on the number of parameters and specific tests the physician completed. 

Example: If the physician conducts a six-hour staged sleep study, you should report 95811 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist), says Karen Dorval, CPC, billing and coding specialist with the Pneumos Clinic in Bismark, N.D.

Watch out: In some instances, the patient may not sleep for the full duration, Dorval says. But if the physician completed and recorded all stages of the procedure, concluded a diagnosis, and documented each step of the stages, you are justified in billing one of the polysomnography codes, she says. 

Question 2: How should we report a polysomnography when the patient decides to discontinue the procedure before reaching the end of the study?

If a physician performs a diagnostic test that does not yield a valid result (e.g., due to a technical error, inadequate sample, etc.), you should not bill for the test, says Vicky O'Neil, CPC, CCS-P, a compliance coordinator in St. Louis, Mo.

If the physician records less than six hours of observations, you should report those studies with modifier -52 (Reduced services) to notify the carrier that the physician completed a reduced service, O'Neil says.

Exception: In some cases, the sleep lab may record six or more hours of data but the lab ends up with less than six hours of interpretable data.

In this case, you should report the professional portion (your physician's interpretation) with modifier -52 because the physician's portion of the service was less than the normal six or more hours, O'Neil says. 

You should then split the billing for the technical portion and report it separately because the lab recorded six or more hours, O'Neil says.


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## sjhazen75 (Apr 17, 2013)

*95811 and 94460?*

Lisa,

Do you have additional information (links, articles), regarding billing of CPT 95811 and 94660.  We understand the initiation is done during 95811, but our Dr. states he can also on another date.  

Thanks,
Sara H., CPC


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