Pulmonology Coding Alert

Our coding experts can help you overcome your OSA coding trouble A patient presents to your pulmonology practice complaining of sleep disturbance and difficulty breathing. You plug the 780.53 diagnosis into your physician's claim for the diagnostic test, and you're done with that chart, right? Not so fast. Sleep apnea patients may require a host of diagnostic and management techniques, and the codes involved can make your head spin. Follow our experts'advice to nail down the right sleep apnea codes every time. Sleep apnea is a dysfunction that results in the cessation of breathing for at least 10 seconds during sleep. Typically, a patient will seek medical attention at the urging of a spouse because the snoring or excessive daytime sleepiness has become unbearable. Preliminary steps: Often, the patient is referred to a pulmonologist. The physician takes a detailed patient  history and performs an examination. If the physician suspects OSA (obstructive sleep apnea), he may schedule the patient for polysomnography.

You should code the visit with 9924x (Office consultation for a new or established patient ...), 9920x (... new patient) or 9921x (... established patient), depending on whether another physician referred the patient to your practice, if the patient is new or established, and the level of evaluation and management the pulmonologist provided. Sleep study results determine how to treat the patient. If the patient has a respiratory disturbance index (RDI) of 20 or more, indicating moderate to severe sleep apnea, the pulmonologist may inform the patient about using a continuous positive airway pressure (CPAP) device that pumps air into the individual's upper airway passages. Many private carriers cover the rental or purchase of a CPAP device for OSA patients.

Here are three tips from our coding experts to help simplify your coding for OSA, central sleep apnea (CSA), and mixed sleep apnea (MSA) and the related coding strategies. 1. Code for the first step: 95808 for diagnosis Three kinds of sleep apnea (OSA, CSAand MSA) indicate the use of polysomnography. OSA (780.53, Hypersomnia with sleep apnea) involves the occlusion of the airway, CSA (780.51, Insomnia with sleep apnea) involves the absence of respiratory effort, and MSA (780.57, Other and unspecified sleep apnea) is a combination of the two.

When your physician begins diagnosing a patient with sleep apnea, the patient usually comes in one evening for polysomnography, stays throughout the night and leaves the following morning, says William J. Conner, MD, physician at Meridian Medical Group, a multispecialty practice in Charlotte, N.C. For a physician to diagnose OSA, he must record at least 30 episodes of apnea during six to seven hours of recorded sleep, Conner says.

Coding tip: How many parameters the physician tests determines the codes you [...]