Pulmonology Coding Alert

Question: My pulmonologist performed only the interpretation component of a split-night polysomnogram. I billed it as 95810-53-26 and 95811-59-26, but the carrier denied the claim. What did I do wrong?

Answer: You should have billed only 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) -- the more extensive service. This service includes the diagnostic sleep study (95810, ... sleep staging with 4 or more additional parameters of sleep, attended by a technologist), along with continuous positive airway pressure (CPAP) therapy titration to the study.

Rationale: Since CCI has bundled 95810 into 95811, coding rules dictate that you should never report them together. In fact, 95808-95811 are part of the same code family, so you only use them one at a time.

Appending modifier 26 (Professional component) is appropriate to indicate the pulmonologist performed only the review and the interpretation of the sleep study. The sleep lab, however, should bill for the polysomnography's recording portion with modifier TC (Technical component).