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
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