Pulmonology Coding Alert

Question: Our pulmonologist performed several studies on a patient during the same sleep study session. We're getting conflicting advice about how many times we can report 95806 for the visit. Can you advise?

Codify Subscriber

Answer: You can report only one unit of 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort [eg, thoracoabdominal movement]), regardless of how many services you performed during the session.

The Vol. 23, Issue 7 edition of CPT^® Assistant clarifies that one unit is the limit, despite multiple services. "Code 95806 is not a time-based code so one incidence of the code includes all of the service involved with one unattended sleep study service," the AMA said.

The MUE (Medically Unlikely Edits) corroborate this by setting an adjudication indicator of "2" signifying a "per day edit based on policy."