Pulmonology Coding Alert

Check documentation for parameters recorded to improve reporting accuracy.

When your pulmonologist performs sleep studies, staging of sleep and parameters that your pulmonologist records drives your reporting for the procedure. Check our guidance that follows to improve your coding skills for a sleep study.

Discern Sleep Studies from Polysomnography

Understanding subtle differences between sleep studies and polysomnography (PSG) will aid your code selection. "Sleep studies and polysomnography refer to a continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review, interpretation and report," says Mary Mulholland, MHA, RN, CPC, with University of Pennsylvania Health System in Philadelphia. These studies will help your pulmonologist assess the patient for sleep disorders and the response to certain therapies (such as CPAP) initiated to overcome these disorders.

Staging is your key: Note that polysomnography tests will usually require your pulmonologist to stage sleep with parameters such as frontal, central and occipital lead electroencephalogram (EEG), left and right electrooculogram (EOG), submental electromyogram (EMG), ECG, airflow (nasal and/or oral), respiratory effort, gas exchange (SpO2), extremity muscle activity (bilateral anterior tibialis EMG), and body positions. In contrast, sleep studies will not need staging and the patient may sometimes remain awake during some tests (such as Multiple Sleep Latency Test [MSLT]).

Sleep studies such as MSLT or the maintenance of wakefulness (MWT) testing are generally performed to assess day time sleepiness and can be performed by your pulmonologist the day after he performs PSG. "The MSLT objectively assesses the patient's sleep tendency by measuring the number of minutes it takes for the patient to fall asleep, as well as the premature occurrence of rapid eye movement (REM) sleep," says Mulholland. "In order to ensure the validity of the MSLT, interpretation should only be made following the PSG performed on the preceding night." MWT involves patient being instructed to remain awake for as long as possible during several 20 or 40 minute sessions while sitting in low-level light.

When your pulmonologist performs MSLT or MWT, you report the services using 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness).

PSG? Choose from 3: When your pulmonologist performs a PSG, you have three coding choices, depending on the number of parameters that your pulmonologist has opted for to record and stage sleep:

• 95808 (Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist)
• 95810 (...4 or more additional parameters of sleep...)
• 95811 (... 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation...)

Example: A 55-year-old male patient reports to your pulmonologist with complaints of restlessness during sleep, frequent arousal from sleep due to a gasping or choking sensation, and recent episodes of daytime sleepiness, one incident that almost caused an accident while driving an automobile. Your pulmonologist performs a comprehensive evaluation of the patient and suspects obstructive sleep apnea. He decides to perform a PSG that records EEG, EOG, submental EMG, ECG, airflow and oxygen saturation followed by a MWT the next day.

Code: You report the PSG with 95808, as your pulmonologist recorded 3 parameters above the standard parameters (EEG, EOG and submental EMG) and the MWT with 95805.

Home in on 95806 for Home Sleep Testing

Medicare allows home sleep testing (HST) to diagnose a patient for obstructive sleep apnea (OSA). "HST is covered for diagnosing OSA if the HST is reasonable and necessary for diagnosing the patient's condition, meets all Medicare requirements, and the physician performing the service has sufficient training and experience to reliably perform the service," says Mulholland. The HST recording should be done over a period of three consecutive nights, but Medicare considers the multiple recordings as one study and will only reimburse it once. You should note that the HST has to be performed using FDA approved devices and the patient should be provided training and instructions on the use of the device.

You report unattended HST for commercial carriers using 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort [e.g., thoracoabdominal movement]). If patient is covered under Medicare, you can choose from one of the G codes mentioned below based on the number of parameters recorded:

• G0398 (Home sleep 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 (Home sleep test [HST] with type III portable monitor , unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation)
• G0400 (Home sleep test [HST] with type IV portable monitor, unattended; minimum of 3 channels)

When sleep studies are performed in a lab and attended by a technologist, you can report the services with 95807 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist).

Don't Forget Modifier 52 for Reduced Services

When you report sleep studies, you will have to have a minimum of 6 hours of interpretable data for you to report these services. "CPT® 95808-95811 procedure codes require 6 hours of data monitoring," says Mulholland. "Report them with modifier 52 (Reduced services) for reduced polysomnography or sleep study services if less than 6 hours of recording were obtained." Use modifier 52 when less than four nap opportunities occur during MSLT/MWT services.