Wiki Billing review of findings for an At Home Sleep Study

[stephmom21@yahoo.com]

Hello,

I do the billing for a PCP. She has JUST started sending patients home with Sleep machines. When the patient brings it back, she then sends it to a different dr/company that reads and interprets it. My question is, when she gets the reports back and has the patient come in for the "review of findings", is there a special code for this? OR is a standard E/M?

I am lost. Please help.

Thank you,
Stephanie

 

[TThivierge]

Info on Sleep Lab Billing

Hi Steph,

I do sleep lab billing for outpatient visit and sleep lab polysomonogram procedure done at hospital. We use POS 22 (outpt. hospital)and CPT codes of 95805 to 95811. Also modifier 26 goes with each of the CPT codes of 95805 to 95811. You must use the bill date on the claim of not the actual date of test but the reading date by the trained physician for sleep labs. If the sleeping hours are under 6 hours add modifier 52 to the claim. In my region of the United States, sleep lab procedures need to be pre-approved by Aetna, United Healthcare and some Anthem policies.

Also go to Medicare LCD to get list of approved dx. codes usually start with G47 block, and you can bill morbid obesity dx codes of Z68 and E66 blocks if it applies to the patient situation. If 2 sleep lab services done on same date, add modifiers 59 and 25 can be used. Per coding scenario. also a series of Z codes can be plopped on claim of course it patient situation applies or corresponds. Here are some Z codes we use..Z78.9, Z86.69, Z72.820 Z72.821 Z99.89. Also if the patient has certain heart condition my doc plops on the pertaining diagnostic code.
oh yes sometimes Circadian Sleep is usually not covered.
Good Luck!