Wiki Correct billing for the reading of a sleep study

[Coral Denham]

Hi, I have a provider who is reading sleep studies done at a local sleep center. She is reading them on a different DOS than the original study. I have seen information that this should be billed with the POS of the sleep center, and the DOS of the original study. I have also seen information advising to bill on the actual DOS of the reading. Does anyone know what the actual industry standard is? I have looked in the CPT Assistant for this but have not found it. I also saw a previous thread advising this answer may be in the March 2018 AAPC magazine, but I also looked there and found nothing. Any advise would be very much appreciated.

Coral

 

[Leandra]

Hi, I have a provider who is reading sleep studies done at a local sleep center. She is reading them on a different DOS than the original study. I have seen information that this should be billed with the POS of the sleep center, and the DOS of the original study. I have also seen information advising to bill on the actual DOS of the reading. Does anyone know what the actual industry standard is? I have looked in the CPT Assistant for this but have not found it. I also saw a previous thread advising this answer may be in the March 2018 AAPC magazine, but I also looked there and found nothing. Any advise would be very much appreciated.

Coral

I would suggest checking payer guidelines; I know some are different in that they will allow the actual DOS or the date the study was read as the DOS; some allow either or date.

 

[MaryG215]

I would suggest checking payer guidelines; I know some are different in that they will allow the actual DOS or the date the study was read as the DOS; some allow either or date.

My sleep provider does a lot of poly interpretations. We use the date the test was read as the DOS and we use the physical location the provider was in (clinic) when he was reading them. We have done a lot of research on the guidelines and there really isn't anything official across the board. The March 2018 article I believe you're referring to states "If the HST device is shipped to the patient's home with a follow-up call to overview the instructions, the place of service (POS) code is 12 Home, and the billing date is the date of the call" (which we believe implies the date of the interp should be the actual date of the read not the date of the sleep study).

 

[SharonCollachi]

I think Medicare's Guidelines are pretty clear here. While a sleep study is not mentioned, enough other tests are that are similar, in that a technical component and a professional component may be done on different days.