Pulmonology Coding Alert

Hint: Polysomnography studies are always attended.

Polysomnography is a sleep study your pulmonologist can order to diagnose why their patient wakes up exhausted after a full night’s rest. But when the tests are complete, do you know which codes to assign to secure reimbursement?

Read on to understand how age, stage, and parameters can lead you to the correct codes.

Know the Differences Between Polysomnography and Other Sleep Studies

Providers perform polysomnography and other sleep studies to monitor and record several parameters of sleep for six or more hours. After each type of test, a physician will review, interpret, and report their findings. Following the review of the findings, providers can assess whether patients have sleep disorders as well as evaluate their patients’ responses to different therapies, such as 94660 (Continuous positive airway pressure ventilation (CPAP), initiation and management) services.

While code descriptors and provider documentation may have similar wording to describe each of these procedures, the term “sleep staging” is what separates polysomnography from other sleep studies. A provider measures a multitude of other parameters that can affect the patient’s sleep, but “the basic parameters of polysomnography are used to stage sleep,” says Carol Pohlig, BSN, RN, CPC, manager, coding & education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia.

Capture a Patient’s Sleep Stages Using Polysomnography

The “sleep staging” portion of the descriptors for the polysomnography CPT^® codes includes measurements captured from the frontal, central, and occipital (back of the head) leads of an electroencephalogram (EEG), submental electromyography (EMG) lead, and left and right electrooculogram (EOG). A submental EMG records electrical activity that helps providers identify sleep onset, micro-arousals, rapid eye movement (REM) sleep, and REM sleep without atonia. Electrooculograms record electrical activity that indicate eye movement. Make sure to double-check the physician’s documentation, as the notes should clearly state these measurements.

You’ll report polysomnography studies using the following codes:

• 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 (… age 6 years or older, 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)
• 95782 (… younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist)
• 95783 (… younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist)

Avoid overbilling: An EEG is a requirement for these studies, so you should not separately report a related EEG when billing for polysomnography.

Understand What Makes Up Additional Parameters

You’ll notice each of the polysomnography code descriptors indicates the provider measures “additional parameters of sleep.” The parameters of sleep are used to determine which stage of sleep the patient is in during the study. Additional parameters that are typically captured during polysomnography studies include:

• Electrocardiogram (ECG)
• Nasal or oral airflow
• Respiratory effort
• Oxyhemoglobin saturation, SpO₂
• Bilateral anterior tibialis EMG, which measures intermittent limb movements while the patient sleeps

“Polysomnography does not have to include all of these additional parameters. The selected codes are dependent upon how many parameters are measured during a given case,” Pohlig says. You’ll assign 95808 if one to three additional parameters are measured, but, if the provider measures at least four parameters, then you’ll need to review the documentation for the patient’s age to determine the correct code.

Additionally, the provider may initiate CPAP therapy or bilevel ventilation during the study to evaluate how well the patient responds to the treatments. If either of these therapies are introduced during the study, you’ll select polysomnography code 95811 or 95783, depending on the age of the patient.

Important: If you report 95811 or 95783, do not also report CPAP code 94660 as it is part of the procedure.

Recognize When to Reduce Services for Sleep Studies

The guidelines for polysomnography codes state the procedure requires the attending technologist or QHP to record the physiological parameters for several hours. The number of hours depends primarily on the age of the patient. Attended polysomnography studies for patients ages 6 years and older require a minimum recording time of six hours but attended polysomnography studies for patients under 6 years of age require at least seven hours of recording.

If the provider doesn’t perform the procedure according to the requirements laid out in the code descriptors, and in cases where the total recording time was less than required, you’ll append modifier 52 (Reduced Services) to your polysomnography code. Modifier 52 “is not used for an incomplete procedure, but for instances where less than the entire procedure was performed,” says Peggy Stilley, CPC, CPB, CPMA, CPC-I, COBGC.

For example, if the technician records the patient’s physiological paramenters for less than six hours, you should append modifier 52 to CPT^® codes 95810 and 95811. You would also append modifier 52 to 95782 and 95783 for less than seven hours of recording.