Pulmonology Coding Alert

Question: I am new to pulmonology coding and our pulmonologist performs many sleep study procedures on our patients and he recently requested the performance of actigraphy recording for a patient. Can you tell me how to report this procedure and whether or not this procedure can be reported with other sleep study procedures like maintenance of wakefulness testing and polysomnography?

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Answer: Actigraphy is a non-invasive recording of gross motor movements that helps your clinician assess the patient’s rest/activity cycles across many days. Actigraphy is useful in evaluating insomnia, circadian rhythm sleep disorders, excessive sleepiness and restless leg syndrome. The minimum actigraphy recording should last three days and for a maximum of fourteen days.

You report actigraphy with 95803 (Actigraphy testing, recording, analysis, interpretation, and report [minimum of 72 hours to 14 consecutive days of recording]). You should not report 95803 more than once for a 14-day period.

If your clinician is also conducting other sleep study procedures, you should be aware of Correct Coding Initiative (CCI) edits that are in place that bundle 95803 with other sleep study codes. So, if your pulmonologist is also testing maintenance of wakefulness which you report with 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness), you cannot also report 95803 as CCI edits bundle these two procedures together with the modifier indicator ‘0,’ which means that these codes cannot be reported together under any circumstances.

Also, if actigraphy is being recorded as part of a polysomnography (PSG), you cannot report 95803 separately with the codes for polysomnography that you report with 95782-95783 (Polysomnography; younger than 6 years…) if the patient is aged below six or 95810-95811(Polysomnography; age 6 years or older…) if the patient is aged above six years. The code 95803 is also bundled into the codes for PSG as per CCI edits with the modifier indicator ‘0.’