Respiratory Question for the Week of May 28, 2018

Question:

Our sleep clinic manager wants to create a checklist to decrease Medicare denials for polysomnography (PSG) codes 95810 and 95811. Can you provide a few examples of reasons for denial that we can include on our list?

Answer:

The following common reasons for PSG denials are a good place to start to improve clinical and administrative practices.

Inappropriate diagnosis codes
Unbundling a split-night service
Double-billing for the professional component
Repeated titrations
Titration with no corresponding treatment device
Missing visit with ordering provider
Repeated PSG services

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

Respiratory Question for the Week of May 28, 2018

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