Neurology & Pain Management Coding Alert
Do You Need a Referral for a Sleep Study?
Question: Our neurologist saw a patient in our sleep center. The patient does not have a referring physician or primary-care physician because his insurance does not require it. Can we perform and code a polysomnography without a referring physician? Tennessee Subscriber Answer: The situation you describe is no different from any other neurological test. If your physician sees the patient, he can refer the patient for a sleep study -- meaning you don't always need a referral from another physician. Report polysomnography with 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) or 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). For other sleep studies, choose the best option from CPT's -Sleep Testing- section with codes 95805-95807. Note: Your neurologist should also complete an assessment of the patient before determining that the sleep study is necessary. Bill this service with the appropriate E/M code (99201-99215).
Neurology & Pain Management Coding Alert
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