Sleep Apnea Diagnostic medical device Kit

Polysomnography continues to be one area of outstanding challenge when coding for respiratory and pulmonary services. Reviewing the foundations of polysomnography will help bolster successful CPT® coding and compliance. By gaining better comprehension of this area, healthcare coding and billing professionals can help ensure accurate coding while safeguarding full reimbursement. Let’s take a look at some of the details that define polysomnography along with two of the associated codes. 

What makes polysomnography different from other sleep studies?

According to the CPT manual, polysomnography is distinguished from sleep studies by the inclusion of sleep staging, which is defined to include an electroencephalogram (EEG) with one to four leads, an electrooculogram (EOG), and a submental electromyogram (EMG). Note that PSG requires at least one central and usually several EEG electrodes. The EEG used during PSG differs from that performed for separate diagnostic purposes. How do these EP procedures work? These electrophysiological (EP) procedures actually record a variety of body functions during sleep, including:

  • electrical activity of the brain,
  • eye movement, muscle activity
  • heart rate, breathing
  • airflow through the nose and mouth,
  • and blood oxygen levels.

It is best to consult the AMA CPT coding guidelines for sleep testing and polysomnography for a complete listing of additional parameters identified as recorded measurements during sleep. Understand that other parameters of sleep may also be monitored and recorded as a component of the sleep study or polysomnography, BUT they would not be billed separately.

Age-specific CPT Description Additions

Age-specific language was finally added in the CPT descriptions for sleep study and polysomnography found in the neurology subsection when the section was updated in 2013. The codes for polysomnography are differentiated by descriptors of “age 6 or older” and “younger than 6 years.“ Facilities that treat pediatric patients who are referred for sleep testing polysomnography will want to be certain that they have accurately updated order entry screens and chargemasters to include these CPT codes for children and infants.

Understanding Study Procedure and Goals for 95782 and 95783

  • 95782 Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist

Revenue Codes: 0510, 0519, 0920, 0929

  • 95783 Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuouspositive airway pressure therapy or bi-level ventilation, attended by a technologist

Revenue Codes: 0510, 0519, 0920, 0929

Polysomnography, as described by codes 95782 and 95783, is a time-consuming and complex procedure lasting approximately 8–10 hours. PSG is an overnight physiologic recording performed in a specialized facility. The procedure is performed by a trained technologist who applies electrodes and other transducers to monitor the EEG, EOG, EMG, ECG, respiratory effort and airflow, oxygen saturation, and other systems as needed. Ultimately, the goal of the study is to monitor multiple physical functions while the pediatric patient, younger than 6 years old, is sleeping.

PSG aids in evaluating the cause of excessive daytime sleepiness, insomnia, or unusual spells that may occur during sleep. Under some circumstances, other sleep disorders, such as sleep apnea or narcolepsy, may be diagnosed. Patients are monitored continuously throughout the procedure on a polygraph or other recording system, and continuous auditory and video recordings are produced as well. Note that it may be required for the technologists to interact with the patient during the night to administer interventions at the physician’s direction.

For example, it may be necessary to apply CPAP at a mid-point during the study to relieve episodes of apnea. The diagnostic procedure initially performed is a PSG identified by 95782. A mask is applied at the point the need for CPAP is identified. At this point, 95783 defines the procedure. This procedure is commonly referred to as a split study. According to information in the AMA CPT Assistant Newsletter (September 2002), understand that initiating CPAP requires an accounting of the frequency of apnea and hypopnea at various points during the sleep test.

Explore more billing tips and insight on both 95782 and 95783 along with other CPT coding for polysomnography by checking out our Coding Essentials for RT/Pulmonary Function.

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