Wiki Coding a negative sleep study

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THELASTKEEPER

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An NPSG or OCST with no evidence of sleep apnea, or an MSLT or MWT with no evidence of narcolepsy, hypersomnia - - --

What should the billable diagnosis be? There seems to be a conflict between the Compliance viewpoint (in the organization I work for) and the common sense approach. I don't seem to get a vote in this as I'm 'just the biller' !

Kinda frosts my onions, but I'm trying to learn everything I can when it comes to situations like this when those above my pay grade battle it out for intellectual superiority.

Any help or information that I can use to bolster my opinion would be most helpful.

Thanks
 
THELASTKEEPER said:
An NPSG or OCST with no evidence of sleep apnea, or an MSLT or MWT with no evidence of narcolepsy, hypersomnia - - --

What should the billable diagnosis be? There seems to be a conflict between the Compliance viewpoint (in the organization I work for) and the common sense approach. I don't seem to get a vote in this as I'm 'just the biller' !

Kinda frosts my onions, but I'm trying to learn everything I can when it comes to situations like this when those above my pay grade battle it out for intellectual superiority.

Any help or information that I can use to bolster my opinion would be most helpful.

Thanks[/QUOTE
I am unsure of what you mean by the compliance approach and the common sense approach. The correct answer is the dx documented by the provider. You can use the symptoms or you can use a V71.- dx for condition not found, followed by the symptoms code. What were you considering as the dx?
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On the NPSG - my understanding was that if the study indicated no evidence of OSA then I was to use the chief complaint/documented symptom as the ICD code
On the MSLT/MWT when there was no evidence of hypersomnia or narcolepsy - if the patient had OSA then that would still be the the diagnosis to use. We do MSLT/MWT exams for DOT exams for truck drivers and a majority of these patients come in with no OSA/symptoms but the requirements for their DOT license dictate that they get the exam anyway. If there are no problems, how do you code that?
The compliance folks at this company are almost fundamentalist, in nature, and believe that everything is black and white. The DOT eval for some of these truckers who come in with no symptoms/complaints does not fit into any of their molds and they are quite flustered because they can't come up with an answer, meanwhile I have 8-10 studies that are sitting in limbo because I can not bill them within our established protocols.
Any avenue you can point me in - especially that I can research and document to take to them and at least get a solid viewpoint on record would be great.

I appreciate the time you have taken to consider my questions and offer some help.

Thank you
 
THELASTKEEPER said:
On the NPSG - my understanding was that if the study indicated no evidence of OSA then I was to use the chief complaint/documented symptom as the ICD code
On the MSLT/MWT when there was no evidence of hypersomnia or narcolepsy - if the patient had OSA then that would still be the the diagnosis to use. We do MSLT/MWT exams for DOT exams for truck drivers and a majority of these patients come in with no OSA/symptoms but the requirements for their DOT license dictate that they get the exam anyway. If there are no problems, how do you code that?
The compliance folks at this company are almost fundamentalist, in nature, and believe that everything is black and white. The DOT eval for some of these truckers who come in with no symptoms/complaints does not fit into any of their molds and they are quite flustered because they can't come up with an answer, meanwhile I have 8-10 studies that are sitting in limbo because I can not bill them within our established protocols.
Any avenue you can point me in - especially that I can research and document to take to them and at least get a solid viewpoint on record would be great.

I appreciate the time you have taken to consider my questions and offer some help.

Thank you
Click to expand...
If the patient has no symptoms or complaints then it is screening so use a V code for screening or it is just routine so use the V70 code for DOT exam.
 
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