Sleep Testing

July 26th, 2017 - Chris Woolstenhulme, CPC, CMRS

Categories: Dental Oral and Maxillofacial Surgery Coding

Once a patient has been evaluated for symptoms associated with sleep apnea, testing is ordered to identify severity and determine treatment.

There are several types of sleep tests, but coverage is based on meeting the criteria for Type I (inpatient facility based) or Type II-IV and Other (home-based sleep tests). All sleep tests require interpretation by a practitioner who holds specific credentials. (See LCD33718).

Type of sleep test and requirements for each are as follows:

Type I Device - Facility based

Continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep with practitioner review, interpretation, and report.
Includes sleep staging (defined as a 1-4 lead electroencephalogram (EEG), electro-oculogram (EOG), submental electromyogram (EMG) and electrocardiogram (ECG).
Must contain the following parameters of sleep: airflow, respiratory effort, and O2 saturation by oximetry.
May be a whole night study or a split night study
Performed to diagnose and initially evaluate treatment

TIP: Even though the patient may be staying the night in an ambulatory care center, freestanding clinic, or even the hospital, the sleep study is NOT considered an inpatient service.

Home Sleep Test (Types II-IV, and Other Devices)

Type II: Monitors and records a minimum of (7) channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory movement/effort and oxygen saturation
Type III: Monitors and records a minimum of four (4) channels: respiratory movement/effort, airflow, ECG/heart rate and oxygen saturation; or,
Type IV: Monitors and records a minimum of three (3) channels, one of which is airflow
Other: Devices that monitor and record a minimum of three (3) channels that include actigraphy, oximetry and peripheral arterial tone and for which there is substantive clinical evidence in the published peer-reviewed medical literature that demonstrates that the results accurately and reliably correspond to an AHI or RDI as defined above. This determination will be made on a device by device basis.

Special Instructions on HST Devices: Prior to the test, the patient must be instructed on how to properly apply a portable sleep monitoring device (provided by the entity conducting the HST and NOT the DME supplier) either face-to-face or via video or telephonic instruction with 24-hour access for inquiries and troubleshooting.

Locations for Sleep Studies
Type	Code(s)	Approved Place of Service
Sleep Studies	95800 95801 95803 95805 95806 95807	11 = Independent diagnostic testing facility (IDTF) or facility-based sleep laboratory 24 = Ambulatory Surgical Center
Polysomnography	95808 95810 95811	11 = Independent diagnostic testing facility (IDTF) or facility-based sleep laboratory 24 = Ambulatory Surgical Center
Home Sleep Testing (HST)	G0398 G0399 G0400	12 = Home 15 = Mobile independent diagnostic testing facility

###

Questions, comments?

If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.

Latest articles: (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox

We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities?

Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code

Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.

ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox

Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.

Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox

According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.

Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox

With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.

COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli

COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.

Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli

2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....