Pulmonology Coding Alert

They may seem similar, but there's a big difference between your physician conducting a "sleep study" versus a "polysomnography." Here's how to report the right code for the right procedure:The Terms Are Not SynonymousCPT currently includes three polysomnography codes:• 95808 -- Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist• 95810 --... sleep staging with 4 or more additional parameters of sleep, attended by a technologist• 95811 -- ... 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.The CPT section guidelines for sleep testing procedures lists the additional parameters of sleep referenced in these code descriptions as: 1) ECG; 2) airflow; 3) ventilation and respiratory effort; 4) gas exchange by oximetry, transcutaneous monitoring, or end tidal gas analysis; 5) extremity muscle activity, motor activity-movement; 6) extended EEG monitoring; 7) penile tumescence; 8) gastroesophageal reflux; 9) continuous blood pressure monitoring; 10) snoring; 11) body positions; etc.A standard polysomnogram -- code 95810, for example -- makes limited use of EEG recording, and these diagnostic studies typically do not provide enough information for a physician to make a diagnosis for a variety of non-sleep-related neurological disorders, says Paul Zyglewski of Neurology Consults P.C. in Smyrna, Tenn. Some neurologic disorders, including sleep-related epilepsy, may require more in-depth EEG study.Polysomnography involves an overnight recording of data with the patient being monitored throughout the night. "A basic EEG can be done in an awake or asleep state, and monitors brainwaves," says Gabriela Gregory, MD, in Las Vegas. "It can be used to monitor the different characteristic patterns in an awake or asleep state as well as any activity caused by stimulation such as a strobe light or hyperventilation. The EEG is used in conjunction with a sleep study or polysomnography to define the different sleep stages, as well as to monitor brain activity in those stages."Editor's note: Look for more polysomnography answers next month.