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Pulmonology Coding Alert

Reader Questions:

Know CMS Criteria for PSG Pay

Published on Sat Sep 26, 2009

Question: Can you explain CMS's criteria for covering sleep studies, whether they occur in a lab or in the patient's home? Also, is there a minimum amount of time that sleep staging must take place before the pulmonologist initiates CPAP? North Carolina Subscriber Answer: The pulmonologist may diagnose obstructive sleep apnea (OSA, 327.23) using one of the following: 1. Polysomnography (PSG) performed in a sleep laboratory (95805, 95807-95811, Sleep study ... attended by a technologist); or 2. An unattended home sleep monitoring device of type II, III, or IV, the latter measuring at least three channels (95806, Sleep study ... unattended by a technologist). The pulmonologist can establish a diagnosis of OSA if the patient meets either of the following criteria using the Apnea-Hypopnea Index (AHI) or Respiratory Distress Index (RDI): • The average of AHI or RDI is greater than or equal to 15 events per hour, or • [...]
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