Pulmonology Coding Alert

Question: Our pulmonologist recently performed ResMed Type II home sleep study, giving patient instructions and having them bring back the equipment the next day. Our pulmonologist interpreted the results. Which CPT^® code should I report? If billing out Type III study, which code should I report? Also, if our MD is only reading a sleep study card (overnight study) for CPAP adjustment purposes, how is this reported?

Minnesota Subscriber

Answer: For the ResMed Type II home study, it depends on payer coverage for the patient. For most commercial carriers, you can report an unattended type II study using 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort [e.g., thoracoabdominal movement]). If the clinician is only providing the interpretation for the sleep studies, and does not own the equipment, you can report the same code with the modifier 26 (Professional component) to let the payer know that you are only claiming for the interpretation and the hospital that owns the equipment will report the same code using the modifier TC (Technical component).

If the patient is covered under Medicare, you’ll have to use G0398 (Home sleep study test [HST] with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation) for a Type II home study and G0399 (Home sleep study test [HST] with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation) for a Type III unattended home sleep study.

If the physician is only interpreting the sleep study data to know whether any adjustments are to be done to the CPAP machine, you can report 94660 (Continuous positive airway pressure ventilation [CPAP], initiation and management) as this contributes to a follow-up management of the CPAP machine). You should use 94660 for the initiation and management of CPAP therapy. You bill this code when the treatment is initiated with the patient, in order to describe the initiation and instruction of the patient. If the patient returns and requires additional instruction on use or other issues related to the use of the CPAP device, you should report this service once again. 94660 is not split into a professional component (26) and technical component (TC), and these modifiers are not to be used with the code.

If, on those occasions, a separately identifiable service occurs (i.e., the physician does not spend the visit solely for management of the patient’s use of the CPAP machine), then you should bill either a level of office visit or 94660, whichever involves the most time and focus of the visit. CCI bundles 94660 into E/M services without the ability to separately report these two services on the same day.