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Pulmonology Coding Alert

Reader Question:

Avoid Home Sleep Monitoring Devices Dilemmas

Published on Mon Jan 30, 2012

Question: We provide the HST Type IV home sleep monitoring device to our patients for conducting home sleep studies. We have been billing G0400 on day one that is being denied as it is in the office setting and 95806-PC for the interpretations by our pulmonologist on the next day. I am now being informed that we need to report the device with G0400-TC and that will be paid. Is this correct?California SubscriberAnswer: As per CMS guidelines regarding claims for home sleep studies, you can bill these studies with a HST Type IV device only if it is to confirm a highly-probable diagnosis of obstructive sleep apnea (OSA, 327.23) for which CPAP therapy is being considered. If the home sleep studies are for any other purpose apart from OSA, it will not be covered and your claim will be denied.While claiming for the device, you will have to check if [...]
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