Neurology & Pain Management Coding Alert

Question: A sleep study was ordered for a patient diagnosed with hypersomnolence. The neurologist included a multiple wake test in the sleep study. What CPT code should I use for the multiple wake test?

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Answer: You should use 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness). Code 95805 is the only sleep study code (95803-95811) that mentionswakefulness testing. Check if you need a modifier on 95805.

Sleep services codes (95805-95811) include recording,interpretation, and report. For cases when the neurologist does only the interpretation, use modifier 26 (Professional component) on the sleep study code.

All sleep studies must have a minimum of six hours.If the sleep study does not last that long, append modifier 52 (Reduced services) to your code.

The multiple wake test measures the patient's ability to stay awake during a time when she is normally awake. During the wakefulness test the physician or technologist records the time it takes the patient to fall asleep during a course of four to five 20-minute nap opportunities provided during the testing period in the sleep lab.

The patient does not need to be asleep during the tests.