Otolaryngology Coding Alert

Question: What CPT Codes should we use for unattended sleep studies?

South Carolina Subscriber

Answer: Presently, there is only one code listed in the CPT Manual as a Category I code for unattended  sleep studies: 95806 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist). Recognizing the potential benefits of unattended sleep studies, the AMA has released two new CPT Codes for unattended sleep studies that will go far in increasing options for these tests. The two new Category III codes were released July 1, 2009, and will be implemented effective Jan. 1, 2010, and should be published in the 2010 CPT.

• 0203T -- Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone) and sleep time

• 0204T --... minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by air flow or peripheral arterial tone).

Use 0203T when measuring heart rate, oxygen saturation, respiratory analysis, and sleep time. When the same parameters are measured except for sleep time, report 0204T. For an unattended sleep study that measures heart rate, oxygen saturation, respiratory airflow, and respiratory effort, use 95806.

Codes 0203T and 0204T, like other sleep studies, require monitoring and recording of other parameters of sleep for six hours or more and also involve recording, interpretation, and report of the tests by the physician. If the procedure lasts less than six hours, though, treat 0203T and 0204T like unlisted procedure codes: Don't append a modifier to these codes.

Why: Category III CPT codes do not have an established relative valuation. Since there is no valuation to reduce, there is no true support for appending modifier 52 (Reduced service). Indicate in box 19 or the electronic equivalent that the study had less than six hours of recording and include an explanatory cover letter of the unattended study.

For more information, go to: www.ama-assn.org/ama1/pub/upload/mm/362/cptcat3codes.pdf.