Pulmonology Coding Alert

Question: A patient with chronic obstructive pulmonary disease (COPD) visited our pulmonology practice because they were experiencing sleep difficulties. The pulmonologist evaluated the patient using an “actigraphy test with recording/analysis, and interpretation/report.”

What code should I use to report the procedure?

Minnesota Subscriber

Answer: You will assign CPT^® code 95803 (Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)) to report the test. This code requires at least three days of testing up to a maximum of 14 days, depending on how much data the physician needs to make a diagnosis.

If a patient with COPD is complaining of difficulty sleeping, and your physician suspects insomnia, they may order special monitoring to evaluate the cause of the sleeplessness and if insomnia is the cause.

Actigraphy helps physicians evaluate insomnia, sleep disorders, circadian rhythm, excessive sleepiness, and restless leg syndrome. The test is a non-invasive measurement of gross motor movements to calculate the patient’s rest and activity cycles over many days. Additionally, the test is often combined with other processes, such as 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness), to check for the presence of a sleep motility disorder.

Remember: You shouldn’t report CPT^® code 95803 more than once in 14 days. The code also carries a note to not use 95803 with the following CPT^® codes:

• 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement))
• 95807 (…, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist)
• 95808 (Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist)
• 95810 (…; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist)
• 95811 (…, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist)

After the pulmonologist evaluates the available data from the actigraphy and any combined mechanisms and confirms a sleep disorder, you’ll need to select the correct ICD-10-CM code to support the medical necessity of the diagnostic study and the evaluation and management (E/M) visit.