Neurology & Pain Management Coding Alert

Question: A patient visited our clinic to undergo polysomnography. She was hooked up to do the sleep staging and six additional parameters of sleep, but an hour later she decided to stop the procedure and leave for personal reasons. Is there a minimum amount of time we have to perform the procedure to bill 95810? Which modifier would be appropriate for this case?

Nevada Subscriber

Answer: You can bill 95810 (Polysomnography; sleep staging with four or more additional parameters of sleep, attended by a technologist), and you should append modifier 52 (Reduced services).

Here's why: To bill for a full sleep study, you have to have six hours or more of recording time. Your study was discontinued after an hour.

With this in mind, remember that a CPT parenthetical note states that you should "report with modifier 52 if less than six hours of recording or in other cases of reduced services as appropriate."