Pulmonology Coding Alert

Question: Our pulmonologist provides interpretations for sleep studies at multiple locations. If the interpretation is for the sleep lab at the hospital where our pulmonologist provides services, we use POS 22 (Outpatient hospital). If it is for our private office location, we use the POS 11 (Office). My question is what POS to use when our pulmonologist contracts for sleep studies interpretations for an independent privately owned sleep lab that is not part of my pulmonologist's professional group/alliances. The sleep facility is reporting POS 81 (Independent laboratory) for the technical component of the sleep studies. We cannot bill our interpretations with POS 81.

Texas Subscriber

Answer: When your pulmonologist contracts with outside entities for the interpretation of sleep studies, report the location in which the interpretation takes place. You are correct in using place of service (POS) as 22 and 11 when your pulmonologist provides interpretations for sleep studies in his/her associated outpatient department of the hospital and in his/her office location, respectively. You are also correct in assessing that you cannot use place of service as 81 for interpretations to sleep studies for a privately owned sleep lab that is not connected to the locations where your pulmonologist is providing services.

The principal requirement for reporting a sleep study interpretation provided by your pulmonologist is to use the modifier 26 (Professional component) to the appropriate sleep study code (95807, Sleep study ... -95811, Polysomnography; sleep staging...) that you are reporting for the scenario. Modifier -26 will indicate to the payers that you are only claiming reimbursements for the interpretation part of the sleep study and the independent lab will claim for the technical component.

The place of service for these contracted interpretations is either your pulmonologist's office location or outpatient hospital location dependent upon where the interpretation took place. You can indicate POS as 11 or 22, as appropriate, in the box 24B on the CMS 1500 form.