Pulmonology Coding Alert

Question: Do carriers consider a 24-hour ECG part of a polysomnography or MSLT? We have some carriers that pay for it and others that do not. I think that since the ECG lasts for 24 hours, carriers should reimburse the physician as long as we attach modifier -59 to the ECG code.

Kentucky Subscriber Answer: According to CPT, "Polysomnography [95808-95811] refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for 6 or more hours with physician review, interpretation and report." And CPT includes sleep staging in this definition. 

CPT also includes a 1- to 4-lead electroencephalogram (EEG), an electro-oculogram (EOG), and a submental electromyogram (EMG) as additional parameters of sleep. 

An electrocardiogram (ECG) counts as an "additional parameter" of sleep.  Since carriers identify the ECG as part of polysomnography, you should not report the ECG separately. 

Multiple sleep latency testing (MSLT) records sleep-wake states. This testing measures four to five 20-minute sleep-wake cycles, each spaced at two-hour intervals throughout the day. The physician records physiological measurements including EEG, EOG, EMG and ECG. Therefore, similarly to polysomnography, you should not report the ECG separately because it is included in the MSLT recording process.