How are sleep studies billed?

For a study to be reported as polysomnography (PSG), sleep must be recorded and organized and must be attended directly by a qualified technologist. Report with modifier 52 if less than 6 hours of recording or in other cases of reduced services. CPT codes 95782, 95783, 95808, 95810 and 95811 include sleep staging. The multiple sleep latency test (CPT code 9580) will be covered for the evaluation of patients with a suspected diagnosis of narcolepsy to confirm the diagnosis.

Other measurements taken during a sleep study (e.g. CPT code 95810 is only covered as stated above (II, B. Home Sleep Studies (HSS) may be considered medically necessary when clinically indicated in the judgment of the treating physician. A second home sleep study may be required to assess the impact of uvulopathopharyngoplasty (UPPP) or other corrective surgeries for OSA after adequate recovery from surgery.

A home sleep study provided in the presence of one of the following contraindications is not a covered benefit. If the patient meets the criteria for a PSG, but one of the following contraindications is present, a PSG will be allowed at the center. CPT 95807 Sleep Study, Simultaneous Recording of Ventilation, Respiratory Effort, ECG or Heart Rate and Oxygen Saturation, Assisted by a Technologist About 40 million people in the United States suffer from sleep problems each year. Not getting enough sleep for a long time can cause health problems.

Many sleep disorders can be managed by primary care physicians; however, when abnormal sleep patterns cannot be easily explained and further evaluation is needed, expert opinion and sleep studies may be needed. Polysomnography (PSG) refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep provided in a sleep laboratory including physician review, interpretation, and report. A technologist supervises the recording during bedtime and has the ability to intervene, if necessary. The studies are done to diagnose a variety of sleep disorders and to evaluate the patient's response to therapies such as continuous positive airway pressure (CPAP).

PSG is distinguished from sleep studies by the inclusion of sleep staging, which requires electroencephologram (EEG), electroculogram (EOG) and electromyography (EMG). PSG and other sleep test monitoring devices are generally classified based on the number of biological sensors applied and the physiological parameters recorded. Usually, sleep studies and PSG for sleep disorders are done in sleep centers or laboratories. However, the diagnosis of OSA for CPAP coverage can also be established using the home sleep test (HST), as indicated in number 2 (sleep apnea) below.

Sleep disorder clinics (centers and laboratories) are facilities where certain conditions are diagnosed through the study of sleep. These clinics (centers and laboratories) are for diagnosis, therapy and research.

Sleep disorder

clinics (centers and laboratories) may offer some diagnostic or therapeutic services, which are covered by Medicare. These clinics (centers and laboratories) may be affiliated with a hospital or an independent center.

Whether a clinic (sleep center or laboratory) is affiliated with a hospital or is independent, coverage of diagnostic services in some circumstances is covered by provisions of law other than coverage of therapeutic services. Diagnostic tests are covered only if the patient has symptoms or complaints of one of the conditions listed below. Most patients who undergo diagnostic tests are not considered hospitalized patients, although they can go to the center at night to get tested and then leave after finishing the tests. If HST is used, tests can be performed in the home environment after application of the sensors and receive information about a monitoring device from the technical, professional, or appropriately trained staff of the sleep center or laboratory.

Overnight stay in the sleep center or laboratory is considered an integral part of PSG, MSLT and MWT, but not for HST. ICD-10 Codes Supporting Medical Necessity Group 1 Code ICD-10 CODE DESCRIPTION G47,10 Hypersomnia, unspecified G47,14 Hypersomnia due to medical condition G47,30 Sleep apnea, unspecified G47,411 Narcolepsy with cataplexy G47,419 Narcolepsy without cataplexy G47,421 Narcolepsy under conditions classified in another part with cataplexy G47,429 Narcolepsy under conditions classified elsewhere without cataplexy G47,11 Idiopathic hypersomnia with prolonged sleep time G47,12 Idiopathic hypersomnia without prolonged sleep time G47,31 Primary central sleep apnea G47,33 Obstructive sleep apnea (adult) (pediatric) G47,34 Sleep-related idiopathic Non-obstructive alveolar hypoventilation G47,35 Congenital central alveolar hypoventilation syndrome G47.36 Sleep-related hypoventilation in conditions classified elsewhere G47,37 Central sleep apnea in conditions classified elsewhere G47,53 Recurrent isolated sleep paralysis G47.54 Parasomnia under conditions classified elsewhere G47.61 Periodic limb movement disorder G47.9 Sleep disorder, unspecified UHA insurance billing guidelines University Health Alliance (UHA) will reimburse polysomnography (sleep studies) when determined to be medically necessary and when it meets criteria guidelines physicians (subject to limitations and exclusions) listed below. D) Safety concerns due to dangerous behavior during parasomnia, excessive sleep interruption of family members, or if pharmacotherapy is contemplated. In this case, the PSG must include a 16- to 18-channel electroencephalogram.

A) Hospital-based sleep laboratory falls within the scope of Joint Commission accreditation for your institution; UHA understands that opinions and approaches to clinical problems may vary. Medical Necessity Related Questions Accepted (see Hawaii Revised Statutes §432E-1). A provider may request that the UHA reconsider the application of the medical necessity criteria in the light of any supporting documentation. A two-night study (CPT 9581), documenting obstructive sleep apnea (OSA) during the first half of the study, followed by adjustment of CPAP during the second half of the study, eliminates the need for a second polysomnogram to adjust CPAP.

A two-night study would be appropriate for patients with a baseline apnea index or AHI of at least 15 episodes per hour or 5 to 14 episodes per hour with documented symptoms of excessive daytime sleepiness, cognitive impairment, mood disorders, or insomnia; or hypertension, ischemic heart disease, or history of stroke cerebral. Because CPT code 95811 includes initiation of CPAP therapy, CPT code 94660 will not be paid separately. Unsupervised home sleep studies are not appropriate and are not covered for the evaluation of obstructive sleep apnea. Polysomnography is required for OSA evaluation; therefore, unsupervised home sleep studies are not covered.

Supervised studies are important to ensure that the monitors are properly connected to the patient and that they do not move during the night. In addition, a supervisor can detect sleeping positions that aggravate OSA and snoring patterns and can identify severe apnea so that CPAP can begin immediately. The Epworth Sleepiness Scale is considered medically appropriate as part of the OSA assessment, but it is performed as part of the patient's evaluation and management and will not be paid separately. The global payment of the UHA for polysomnography includes the payment of the EEG, the EOG and the EMG.

These services will not be paid separately. A blog administrator has removed this comment. Very interesting diagnostic method, sounds like magic ????. For example, many Medicare and private insurance policies require board certification in sleep medicine in order to interpret both polysomnography and HSAT.

Itamar Medical's Cardio Sleep Solutions has developed the Watchpat home sleep apnea test for the monitoring, diagnosis and treatment of obstructive sleep apnea. Some payers do allow board-eligible physicians to interpret studies without being overread by a board-certified physician. Suspected sleep disorder other than OSA (such as central sleep apnea, narcolepsy, restless legs syndrome, circadian rhythm disorder, parasomnias, periodic limb movement disorder) 6.Suspected seizure disorders as a possible cause of parasomnia are adequately evaluated by standard or prolonged sleep EEG (electroencephalogram). There are no differences in Epworth, MSLT, mean sleep latency, or other parameters in those with sleep ≥ 10 hours or ≤ 10 hours.

Doctors without board certification in sleep medicine should consult with each insurance provider they work with to determine if they can interpret sleep studies without being read too much. The Multiple Sleep Latency Test (MSLT) involves four or five 20-minute nap opportunities offered at 2-hour intervals. For a patient who undergoes an unsupervised home sleep study using three or more parameters, but who does not meet the criteria for 95806, 95800 or 95801 is used. .