Neurology & Pain Management Coding Alert

Hint: Testing versus treatment draws the line between 95810 and 95811.

A split night sleep study is one way for physicians to potentially diagnose and begin treating a patient's sleep problem in the same night. You must meet certain criteria before reporting the study, however, so read on for tips on how to keep your split night claims on track.

Verify Documentation Supports Split Study

During a split night study, the patient comes in and begins the test as usual. If moderate or severe sleep apnea is discovered or strongly suspected during the first part of the night's study, the second half of the night can be used to determine the necessary CPAP pressure required to alleviate the patient's apnea.

Key: "The patient must meet the protocol for the technician to use a CPAP while there's still enough time to titrate the appropriate levels for the patient," says Jill Young, CPC, CEDC, CIMC, owner of Young Medical Consulting in East Lansing, Mi., during the audioconference "Update on Sleep Disorders Coding and Billing for 2011".

Verify that you have clear documentation of the patient's progress toward meeting protocol before assuming it's correct to report a split night study. Test documentation should include as much information as possible to demonstrate the severity of the patient's sleep-disordered breathing and the physiological impact the sleepdisordered breathing is having on the patient before starting CPAP therapy. Ideally, the test should document an entire sleep cycle and a "worst case scenario" that would include the presence of rapid eye movement (REM) sleep and obstructive sleep apnea (OSA) occurring while the patient sleeps in the supine position.

Watch for Additional Sleep Parameters

Before assigning your study code, look for additional sleep parameters. These can include:

• electrocardiogram (ECG)
• airflow
• ventilation and respiratory effort
• gas exchange by oximetry, transcutaneous monitoring, or end tidal gas analysis
• extremity muscle activity, motor activity-movement
• extended EEG monitoring
• penile tumescence
• gastroesophageal reflux
• continuous blood pressure monitoring
• snoring
• body positions.

Your challenge: Take it as a challenge to make sure your neurologist documents all the necessary elements for the additional parameters, says Cheryl Klarkowski, RHIT,CPC, a coding specialist with BayCare Clinic. You can smooth the process by becoming familiar with your physician's dictation style to ensure you're coding the proper sleep study.

Mechanics: Sleep staging includes a one- to four-lead electroencephalogram (EEG), an electrooculogram (EOG), and a submental electromyogram (EMG). The elements listed above are "considered additional parameters, but do not define the difference between the basic sleep study and sleep staging," explains Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.

Choose the Correct Code and Modifiers

The presence of one or all of the parameters listed above helps narrow your code choices. CPT® currently includes three diagnostic polysomnography codes:

• 95808 -- Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
• 95810 -- ... sleep staging with 4 or more additional parameters of sleep, attended by a technologist
• 95811 -- ... 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.

If you're coding for a split night study, however, you really only have one code choice: 95811. The descriptor notation "with initiation of continuous positive airway pressure therapy ..." is your clue that the study includes a diagnostic portion as well as an actual treatment portion.

Test results give the physician a very accurate one-night diagnostic sleep test.

Final checks: Sleep service codes include recording, interpretation, and report. If your neurologist only performs the interpretation, append modifier 26 (Professional component) to the study code. All sleep studies must also last a minimum of six hours. If the study does not last that long, append modifier 52 (Reduced services) to the sleep study code.