Pulmonology Coding Alert

Question: A patient underwent an unattended sleep study session where the pulmonologist ordered recording of multiple measurements during the session.

I’m new to pulmonology coding and unsure if I should report multiple units of 95806. Could you please point me in the right direction?

Texas Subscriber

Answer: You can report 95806 (Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)) only once per session, regardless of how many services the provider performs during the session. When you look over the descriptor for 95806, you’ll notice the code covers multiple measurements, such as:

• Heart rate
• Oxygen saturation
• Respiratory airflow
• Respiratory effort

CPT^® Assistant, Volume 23, Issue 7, confirms that one unit is the limit, even if multiple services are performed. According to the American Medical Association (AMA) in the publication, “95806 is not a time-based code so one incidence of the code includes all of the service involved with one unattended sleep study service.”

Additionally, Medicare’s Medically Unlikely Edit (MUE) for 95806 is “1,” and the MUE adjudication indicator (MAI) is listed as a “2.” This MAI signifies a “per day edit based on policy,” which indicates that more units than the MUE value would be extremely unlikely to occur on the same date of service for the same patient. Medicare and other payers who apply this MUE will deny any units beyond 1 for 95806.