Do you know that almost 40 million Americans often encounter various issues related to their sleep? You might have already realized that not getting adequate sleep causes health problems for many of your patients. However, the majority of non-severe sleeping disorders are managed by primary care physicians but there are patients who suffer from serious disorders where you must perform further evaluation and sleep studies to treat their problems. In many cases, you need to perform polysomnography which is a process of continuous monitoring and recording of various physiological and pathophysiological patterns of sleep conducted in your sleep study facility. As a sleep study specialist, you review a physician’s note and interpret and create a consolidated report. Your technician needs to monitor the end-to-end recording of your patient’s sleep time and they always have the flexibility to intervene when it is necessary.
It is really crucial for you to diagnose sleep disorders and check how well therapies like CPAP work. When you are running a sleep study practice, you must understand all the basics of polysomnography and sleep study billing services so that you can always receive optimal payments in time. Always remember one thing you can always enjoy a perfect cash flow by having a streamlined sleep study billing service.
The critical things that you must understand is the sleep study coding process, documentation requirements and prior authorization formality as per the latest regulations and policies.
Know about the latest polysomnography codes in your sleep study billing services:
You will use some common CPT codes for polysomnography and sleep testing, and they’re listed below. You must ensure that you are having the right paperwork when you are assigning codes. Also, don’t forget to check each payer’s specific rules to make your coding process perfect.
- You should bill non-attended sleep studies using the CPT/HCPCS code that best matches the service you provided. That way, you make sure everything is accurate and gets paid correctly.
- You should bill CPT code 95811 for split night studies by itself because it already includes CPT code 95810. This code covers polysomnography for patients 6 years or older, with sleep staging and 4 or more additional sleep parameters, all attended by a technologist. So, just use CPT code 95811!
- You should always remember that for a study to be reported as polysomnography (PSG), sleep has to be recorded, staged, and watched by a qualified technologist. You should always report with modifier 52 when a sleep study runs less than 6 hours or if there are less number of services.
- It is important for you to know that CPT code 95808 covers reimbursement for one to three additional parameters. Codes 95782, 95783, 95810, and 95811 cover four or more additional parameters. So, you shouldn’t bill separately for extra parameters when you’re already using these codes because Medicare doesn’t allow it.
The other critical parameters of sleep that you should not forget to include are-
- ECG
- Airflow
- Ventilation and respiratory effort
- Gas exchange by oximetry, transcutaneous monitoring or end-tidal gas analysis
- Extremity muscle activity and motor activity movement
- Extended EEG monitoring
- Penile tumescence
- Gastroesophageal reflux
- Continuous blood pressure monitoring
- Snoring
- Body position
Documentation requirements of your sleep study billing services:
- You need to keep all the documentation in the patient’s medical record and make sure you can show it to the contractor if they ask for it.
- You must make sure every page of the record is easy to read and includes the right patient information, like their full name and dates of service. You also need to include the clear, readable signature of the doctor or non-physician practitioner who took care of the patient.
- You need to make sure the medical record you send matches the ICD-10-CM code you pick. The CPT/HCPCS code you use should explain what service you did. For example, if you treated someone for sleep apnea, your records should show that, and the codes should match the treatment you gave.
- You need to include the ordering doctor’s NPI on the claim form when you’re billing for a sleep disorder test. You also have to keep the doctor’s order on file to show it’s all correct.
Finally, when you are billing for a sleep study like polysomnography, it is really crucial for you to obtain prior authorization before going ahead with the test on your patients.
Prior authorization guidelines for polysomnography in sleep study billing services:
You must need prior authorization approval from a patient’s insurance company before you administer a sleep study test like polysomnography. Missing PA approval may cause your practice to encounter claim denials and full out-of-pocket payments for your patients. It is always important for you to follow proper pre-auth steps in your sleep study billing process to have faster approvals and clean claims.
You must take sleep study billing services seriously if you want your practice to succeed. When you focus on proper coding, accurate documentation, and prior authorization, you can ensure timely payments. That way, you keep your cash flow strong, while ensuring the best patient outcome!
Sunknowledge Services Inc. – an ISO 27001:2022 certified, American-owned & operated company, headquartered in New York City – is a leading global provider of Business and Knowledge Process Outsourcing services in the US healthcare domain.
