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Pulmonology Coding Alert

READER QUESTIONS:

Ensure Correct Sleep Study Diagnosis, Equipment

Published on Fri Oct 23, 2009

Question: We have reported an unattended home sleep study with 95806 with place of service code 4, but have been denied. Does Medicare in fact cover home sleep studies? California Subscriber Answer: Yes, CMS announced March 3 that it will cover specified sleep tests that pulmonologists use to confirm the diagnosis in patients who have clinical signs and symptoms of obstructive sleep apnea (OSA, 327.23). The agency will cover tests your pulmonologist conducts in a sleep laboratory facility in addition to many types of home sleep testing. You are correct to report an unattended study with 95806 (Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, unattended by a technologist), unless you are reporting to Medicare or another payer who recognizes only G0398-G0400. Important: The policy does not apply to the use of sleep testing for other purposes beyond the diagnosis of OSA, according [...]
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