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Split nite polysomnography'95811'

Amy Posted Fri 18th of November, 2011 15:24:03 PM

This is the code that we are using for split nite polysomnograhy. Our techs are indicating that this involves alot of work on there part and are wondering if we can add any modifier to indicate the extra work and time involved on there part. The only modifier I can think of is 22. Is this allowable with this code?

SuperCoder Answered Fri 18th of November, 2011 20:50:15 PM

Code 95811 refers to a dedicated CPAP/bilevel titration study or a split-night study. Medicare coverage for CPT 95811, a study involving CPAP/bilevel titration, is dependent on the following specific criteria:
(1) an AHI of at least 30/h is documented during a minimum of 2 hours of diagnostic polysomnography (note that the AHI is utilized for this definition; it is determined by the total number of apneas plus the total number of hypopneas divided by total number of hours of sleep in the study; this is in contrast to the RDI, which also includes respiratory events that do not meet criteria for an apnea or a hypopnea but which disturb sleep);
(2) AHI of 5 to 15/h should be documented in a patient with a stroke, excessive daytime somnolence, or ischemic heart disease;
(3) CPAP/bilevel titration is performed for > 3 h; and
(4) evidence of OSA is documented during a minimum recording time of 2 h of diagnostic polysomnography.

If sleep studies are terminated before obtaining 6 h of recording time, the “-52” modifier, which indicates limited service, must be used. For example, in the case of a patient who was intolerant to CPAP during the titration segment of a split-night study resulting in a premature termination in testing, the polysomnogram would be coded 95811–52.

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