Pulmonology Coding Alert
Reader Question ~ Use 52 on Incomplete Sleep Study
Michigan Subscriber
Answer: When a physician performs a diagnostic test that does not yield a valid result (e.g., due to a technical error, inadequate sample, increased patient risk, etc.), you should not bill for the test.
If a sleep study has fewer than six hours of observations, you should report those studies with modifier 52 (Reduced services) to notify the carrier of the reduced service.
Exception: In some cases, six or more hours of data may be recorded, but the lab ends up with fewer than six hours of interpretable data.
In this case, if the physician cannot make a definitive diagnosis, the pulmonologist should report the professional portion (physician's interpretation) with modifier 52 because the physician's portion of the service was unable to be completed.
Example: If a sleep lab monitors and records a patient for seven hours during a polysomnography, but the report only contains four hours of useable data, the lab would report 95810 (Polysomnography; sleep staging with four or more additional parameters of sleep, attended by a technologist) with modifier TC (Technical component) for the technical component.
The pulmonologist would report the professional, reduced component, with modifiers 26 (Professional component) and 52 to a second charge of 95810.
Tip: Don't leave your sleep study vulnerable to denials--document where the tests occurred and who attended them.
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