Pulmonology Coding Alert

Question: I have a physician who will begin to do Home Sleep Studies shortly. I need help as to how to code these. Also I need to know if there are special coding requirements for Medicare.

New Jersey Subscriber

Answer: Sleep studies fall into four types:

• Type I is an overnight sleep study at a sleep disorders center that detects obstructive sleep apnea (OSA) and other sleep disorders. Technicians record at least 12 channels of information during the study.
• Types II, III, and IV studies are home sleep tests (HST) to detect OSA. A Type II study records seven or more channels of information; a Type III study records a minimum of 4 channels of information; and a Type IV study records 1 to 3 parameters of information. Type III is most commonly used for home testing.

Your equipment might dictate how many channels your pulmonologist can monitor, and the payer might dictate your reimbursement. Some payers do not pay for Type IV studies, so be sure to research your major payers.

You report unattended HST for commercial carriers using 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort [e.g., thoracoabdominal movement]).

Medicare allows home sleep testing to diagnose a patient for obstructive sleep apnea (OSA). It is not covered for persons with comorbidities (moderate to severe pulmonary disease, neuromuscular disease or congestive heart failure).The HST recording should be done over a period of three consecutive nights but Medicare considers the multiple recordings as one study and will only reimburse it once. You should note that the HST has to be performed using FDA approved devices and the patient should be provided training and instructions on the use of the device.It is covered only when it is performed in conjunction with a comprehensive sleep evaluation and in patients with a high pretest probability of moderate to severe obstructive sleep apnea.

If patient is covered under Medicare, you can choose from one of the G codes mentioned below based on the number of parameters recorded and the type of equipment used:

• G0398 (Home sleep test [HST] with type II portable monitor unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort, and oxygen saturation)
• G0399 (Home sleep test [HST] with type III portable monitor , unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation)
• G0400 (Home sleep test [HST] with type 4 portable monitor,  unattended;  minimum of 3 channels).