Pulmonology Coding Alert

Answer: You have a choice of three codes for adults based on the number of parameters the physician measures during the study. For a procedure that is monitored for one to three parameters, you should use 95808 (Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist). Code 95810 (Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist) for reporting a sleep study that measured four or more parameters. If your physician had to apply continuous positive airway pressure (CPAP) therapy during the procedure in addition to measuring more than three parameters, you will report 95811 (…with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist). 

 

Caution: The presence of a technologist is a must for correct reporting of the study. Typically, a technician performs the studies, and the pulmonologist supervises and interprets the results. Moreover, do not report 95803 (Actigraphy testing, recording, analysis, interpretation, and report [minimum of 72 hours to 14 consecutive days of recording]) in conjunction with any of the polysomnography codes discussed earlier. 

 

If you are reporting only the physician’s interpretation for this service, you should append professional component modifier 26 to the code.

 

The technical component for this service is reported by appending technical component modifier TC to the. In that case, do not append modifier TC because the facility’s portion is inherently technical.

There are separate codes if you have a pediatric case and the patient is less than six years old. In such a case, you have two special codes 95782 (Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist) and 95783 (…with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist) which can also be reported with the professional and technical components.

 

Pulmonologists use polysomnography studies to diagnose several sleep disorders. A technologist attends this sleep study, which is a test that measures biophysiological changes that happen while a patient sleeps. Various parameters such as eye movement, heart rate, respiratory effort, airflow and blood oxygen levels are recorded during a polysomnography. The sleep pattern of the patient is monitored over a period of six hours or more.

 

Don’t miss: Check if the technologist has performed these tests to constitute a successful polysomnography: EEG, EOG, EMG (chin and leg), pulse oximetry, ECG, respiratory flow, respiratory effort, Esophageal pH monitoring and blood pressure monitoring. 

The physician may also check these additional parameters: