Neurology & Pain Management Coding Alert

Be Aware of Bundling Issues With 95805-95811


- Published on Tue, Jul 01, 2003

Sleep studies and polysomnography (95805-95811) bundle a number of important services beyond those specified in the individual code descriptors (for example, CPT lists penile tumescence, 54250, as an included component of polysomnography). Therefore, when reporting procedures 95805-95811, be sure to check the National Correct Coding Initiative (NCCI) before separately reporting other services. A partial list of bundled services, as derived from the most recent version of NCCI (version 9.1, effective until July 1, 2003), includes the following:
 
Code 95805 includes:

  Electrocardiogram (ECG): 93000, 93005, 93010,93040, 93041, 93042, 93224, 93225, 93226, 93227, 93230, 93231, 93232, 93233, 93235, 93236 and 93237
  Maximum breathing capacity: 94200
  Continuous positive airway pressure ventilation: 94660
  Noninvasive ear or pulse oximetry: 94762
  Electroencephalogram (EEG): 95827

 Code 95807 includes:
 
All of the above, plus unattended sleep study 95806 (note that unattended sleep studies are generally not reimbursed by Medicare or other payers).
 
Codes 95808-95811 include the above, plus:
 
  Penile tumescence: 54250
  Determination of resistance to airflow: 94360
  Pulmonary stress testing: 94620
  Carbon dioxide, expired gas determination by infrared analyzer: 94770
  Electroencephalogram (EEG): 95812, 95813, 95816, 95819, 95822, 95824 and 95827
  Electromyography (EMG): 95860, 95861, 95863,  95864, 95867, 95868, 95870 and 95872
  Nerve conduction studies (NCS): 95900 and 95904
  Special EEG tests: 95953, 95956 and 95962.



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