Pediatric Coding Alert

Code 94777 can stand alone in the office.

Zoom in on length and purpose to avoid stumbling through coding sleep-recording services and waking up in denial land.

See if you can solve this case study: "When I use 94777 for pneumogram/circadian respiratory (MMU/CR) monitor interpretations with place of service (POS) 11, 21, or 22 for my neonatology group, many insurers deny the service," relates a Pediatric Coding Alert subscriber. "I used to use old code 94772 with modifier 26, and POS 21 or 22. Now I use 94777 mostly with POS 11 and no modifier. Some payers deny for incorrect POS, and one insurer requests a modifier other than 26. With 94777, what POS is appropriate, and do I need a modifier?" she asks.

The code you cited (94777) is for pediatric home apnea monitors. Codes 94774-94777 are for ongoing monitoring of cardiorespiratory events for parental intervention, explains Ann C. Halbower, MD, in "Pediatric Home Apnea Monitors: Coding, Billing, and Updated Prescribing Information for Practice Management," published in the American College of Lung Physicians' August 2008 CHEST (134; 425-429).

For month-long apnea monitoring events, use 94777 (Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; physician review, interpretation, and preparation of report only). "Code 94777 is a 30-day code for apnea monitoring interpretation by a physician, plus a report," says Alan L. Plummer, MD, at Emory University School of Medicine in Atlanta. "The POS should be for an outpatient only," POS 11 or 22. Modifier 26 is incorrect since 94777 represents the interpretation and report.

You need to use 94772 (Circadian respiratory pattern recording [pediatric pneumogram], 12-24 hour continuous recording, infant), which is for diagnosis of sleep-disordered breathing in a child, says June M. Gerow, RN, CCP, pediatric reimbursement compliance officer at Golisano Children's Hospital at Strong in Rochester, N.Y. Code 94772 is still active and is defined as a 12-24 continuous hour Circadian rhythm reading,

If your group is interpreting overnight pneumogram lab results, use 94772 with modifier 26 (Professional component). Assign the POS for the patient's location, such as inpatient (POS 21) or outpatient (POS 22) hospital.