Pulmonology Coding Alert

Question: Our pulmonologist has begun performing sleep studies on COPD (chronic obstructive pulmonary disease) patients with sleep apnea (780.5x). What are some tips for accurately reporting these studies?

Michigan Subscriber Answer: If you report sleep testing (95805-95807), you should know that your pulmonologist does not stage the study and that the patient may be awake.

Typically, you will code sleep studies when the pulmonologist treats conditions such as sleep apnea (780.5x), narcolepsy (347), and chronic respiratory failure (518.83). You can choose from three CPT codes: 

 95805 -- Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness.

A pulmonologist usually performs this test during the day following polysomnography to measure sleepiness. The physician records the time it takes the patient to fall asleep during a course of four to five 20-minute nap opportunities offered at two-hour intervals.  95806 -- Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist.

Although CPT provides 95806 for unattended tests, don't expect to get paid when you report this code. Medicare carriers, such as National Heritage Insurance Company of Northern California, will not pay for these tests that technologists don't supervise.  95807 -- ... attended by a technologist.

This code represents a standard sleep study, which a technologist or physician attends and includes monitoring of respiratory effort and heart rate. Your physician should note the patient's positions during sleep.

For the pulmonologist to report professional services, the physician must provide an interpretation and report of the studies. The physician may append modifier -26 (Professional component) to the appropriate code (that is, 95805-26 or 95807-26) for the interpretation and other professional services. Because doctors typically perform "attended" sleep studies in a sleep disorder clinic or outpatient hospital facility, the facility will report the technical component of the service (e.g., 95805-TC or 95807-TC).