Pulmonology Coding Alert

Question:  What is a polysomnography, what types of patients need it, and how do you code for it?


Montana Subscriber

Answer: A polysomnography is a study that records a patient's body and brain activity during sleep. Eye movement, heart rate, respiratory effort, airflow and blood oxygen levels are typically measured during a poly-somnography. Pulmonologists use these studies to diagnose several sleep disorders.

Must-haves: During a nocturnal polysomnogram,  the following must be performed: EEG, EOG, EMG (chin and leg), ECG, respiratory flow, respiratory effort and gas exchange by oximetry. Other parameters the physician may test during the study include:

• Extremity muscle activity, motor activity,
• Extended EEG monitoring,
• Penile tumescence,
• Gastroesophageal reflux,
• Snoring and
• Body positions.

Coding: Choose from one of three polysomnography codes, depending on the number of parameters the physician measures during the study. If the study includes measurement of one to three parameters, report 95808 (Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist)

If the study measures more than three parameters, then you should report 95810 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist)

If the study measures more than three parameters and the pulmonologist has to use continuous positive airway pressure (CPAP) therapy during the encounter, use 95811 (... sleep staging with 4 or more parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist).

Remember: In order to report any of the polysomnography codes, a technologist must attend the study.  Typically, a technician performs the studies, and the pulmonologist supervises and interprets the results.

If there are less than six hours of recordings during the study, make sure to attach modifier 52 (Reduced services) to the polysomnography code.