Pulmonology Coding Alert

Question: A patient slept for less than six hours and had polysomnography recording of less than six hours. Can I still report 95810?

New York Subscriber

Answer: For less than six hours of recording, you can still report polysomnography (95810) and polysomnography with CPAP titration (95811) -- possibly with modifier 52 (Reduced services) -- provided you can make a definitive diagnosis prior to that time.

Sleep studies and polysomnography (PSG) refer to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review, interpretation, and report. For a study reported as a polysomnogram, the pulmonologist must record and stage sleep.

Check your payer's instructions. For those specific circumstances that warrant less than six hours of monitoring and recording of PSG, you may want to report modifier 52 to signify that the pulmonologist performed a "reduced service" so that the payer reimburses it accordingly. Under these circumstances, maintain specific documentation in the patient record as to why a shortened study was "reasonable and necessary."