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SLEEP STUDY CODING

Billing Posted Fri 24th of April, 2015 08:21:55 AM

IF OUR OFFICE LEASES THE SLEEP STUDY MACHINE THAT WE GIVE TO OUR PATIENTS TO PERFORM HOME SLEEP STUDIES, WHAT IS THE CORRECT CODE TO BILL OUT TO COMMERCIAL INSURANCES?

SuperCoder Answered Mon 27th of April, 2015 06:01:06 AM

If for an unattended home sleep study, the patient uses a type III portable monitor with a minimum of four channels to evaluate two respiratory movements, or airflow, one ECG or heart rate and one oxygen saturation, use G0399, Home sleep test, or HST with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement or airflow, 1 ECG heart rate and 1 oxygen saturation.
If for an unattended home sleep study, the patient uses type IV portable monitor with a minimum of three channels, use G0400, Home sleep test, or HST with type IV portable monitor, unattended; minimum of 3 channels.
Other payer may use and the provider, who interprets the home sleep study test, uses one of the following codes. The provider adds a modifier 26, Professional component when reporting his services. These CPT may also be reported for sleep study services: 95806; Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort ,eg, thoracoabdominal movement, 95800; Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis, eg, by airflow or peripheral arterial tone, and sleep time and 95801; Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis, eg, by airflow or peripheral arterial tone. Check with the individual payer for their reporting requirements.

Billing Posted Mon 27th of April, 2015 08:20:19 AM

I guess what I'm asking is because the machine is leased by us to give to the patient do we bill 95806 or 95806-26? We don't bill out our medicare patients because the company we lease from does, we bill out just our commercial patients.

SuperCoder Answered Tue 28th of April, 2015 03:47:09 AM

If you are proving only the supply (machine), bill CPT code with the TC modifier for the technical component. If professional service is also being provided, bill the CPT code without any modifier.
I hope this information will be helpful.

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