Pulmonology Coding Alert

Question: If a nurse practitioner (NP) performed an H&P (history and physical exam) or a subsequent visit with a patient prior to a sleep study, can you bill the H&P with modifier 25 and the sleep study code? Is the H&P included in the sleep study?

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Answer: The visit has to be an evaluation for something other than scheduling a sleep study. It is fairly unusual that the pulmonologist would see the patient in the daytime and conduct a sleep study on the same night. Because the sleep study would usually occur on a different day (and perhaps for a different reason), you should code 99201-99205 or 99211-99215 (Office or other outpatient visit, for the evaluation and management of an established patient ...) one day and 95811 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist) on a different day. Remember a NP should report the patient evaluation in her own name.

Note: A cursory H&P (immediately prior to initiation of the study) is not separately reported from the sleep code.

Another option: If the NP only saw the patient, then the NP would code 99201-99215 and the practice would receive 85% of the payment. The pulmonologist would code for the sleep study separately.