Neurology & Pain Management Coding Alert

Coding these different procedures incorrectly could raise a red flag for auditors. They may seem similar, but there's a big difference between your neurologist conducting a -sleep study- versus a -polysomnography.- Here's how to report the right code for the right procedure to help ensure your neurologist is getting his due " and avoiding an audit for incorrect coding. Polysomnography and Sleep Studies Are Not Synonymous There are currently three CPT codes for polysomnography:
- 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. The CPT section guidelines for Sleep Testing Procedures lists the additional parameters of sleep referenced in these code descriptions as: 1) ECG; 2) airflow; 3) ventilation and respiratory effort; 4) gas exchange by oximetry, transcutaneous monitoring, or end tidal gas analysis; 5) extremity muscle activity, motor activity-movement; 6) extended EEG monitoring; 7) penile tumescence; 8) gastroesophageal reflux; 9) continuous blood pressure monitoring; 10) snoring; 11) body positions; etc. Tip from the field: A standard polysomnogram " code 95810, for example " makes limited use of EEG recording, and these diagnostic studies typically do not provide enough information for a neurologist to make a diagnosis, says Paul Zyglewski of Neurology Consults, P.C., in Smyrna, Tenn. A variety of neurologic disorders, including sleep-related epilepsy, may require a more in-depth EEG study. Polysomnography involves an overnight recording of data with the patient being monitored throughout the night. -A basic EEG can be done in an awake or asleep state, and monitors brainwaves,- says Gabriela Gregory, MD, in Las Vegas. -It can be used to monitor the different characteristic patterns in an awake or asleep state as well as any activity caused by stimulation such as a strobe light or hyperventilation. The EEG is used in conjunction with a sleep study or polysomnography to define the different sleep stages, as well as monitor brain activity in those stages.- Sleep Studies Have Separate Codes On the other hand, the following codes refer specifically to sleep studies: - 95805 -- Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
- 95806-- Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist
- 95807 " Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist. Term tip: The multiple sleep latency test (MSLT) and the maintenance of wakefulness test (MWT) are similar in [...]