Neurology & Pain Management Coding Alert

Question: My physician had a patient perform a home sleep test for obstructive sleep apnea. What are the correct codes for home sleep testing?

Maine Subscriber

Answer: The codes you need for home sleep testing are:

• G0398 -- Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation

• G0399 -- ... with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation

• G0400 -- ... with type IV portable monitor, unattended; minimum of 3 channels.

The physician services related to these codes are covered for the purpose of testing a patient for the diagnosis of obstructive sleep apnea if the home sleep testing is necessary for the diagnosis of the patient's condition. The procedure must also meet all other Medicare requirements, and your neurologist must have sufficient training and experience to reliably perform the service.

Your neurologist -- the physician performing the home sleep study service -- must meet one of the following criteria:

• Is a diplomate of the American Board of Sleep Medicine (ABSM), or

• Is a diplomate in sleep medicine by a member board of the American Board of Medical Specialties (ABMS), or

• Is an active staff member of a sleep center or laboratory accredited by the American Academy of Sleep Medicine (AASM) or The Joint Commission.

Additionally, many payers include the following restrictions in their coverage policies for home sleep study testing: "Home sleep testing is not covered for persons with comorbidities (moderate to severe pulmonary disease, neuromuscular disease, or congestive heart failure), other sleep disorders (central sleep apnea, periodic limb movement disorder, insomnia, parasomnias, circadian rhythm disorders, or narcolepsy), or for screening asymptomatic persons."