Pulmonology Coding Alert

Question: Our pulmonologist used actigraphy to evaluate an asthma patient for sleep difficulties. Which code should we report for this service?

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Answer: If your asthma patients complain of sleep difficulties and your physician suspects insomnia, they may order special monitoring to determine the exact nature of the sleeplessness and whether it’s insomnia.

To track sleeplessness patterns, your pulmonologist may request actigraphy — a non-invasive recording of gross motor movements that helps 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 (72 hours). It is often used with a combination of other mechanisms (for example, Multiple Sleep Latency testing) to determine the presence of a sleep motility disorder.

When allowable, report actigraphy with 95803 (Actigraphy testing, recording, analysis, interpretation, and report [minimum of 72 hours to 14 consecutive days of recording]).

The timing: Code 95803 covers a minimum of three days up to a maximum of 14 days, depending on how much data is needed. Charges are not per-day.

Remember: Don’t report 95803 more than once for a 14-day period. CPT^® coding guidelines also instruct that you should not report 95803 in conjunction with the codes for sleep studies and polysomnography.

If your pulmonologist confirms a sleep disorder from the available data including actigraphy results, you’ll need to select the right ICD-10 code to support the medical necessity for the diagnostic study and the office visit.