Respiratory Question for the Week of May 8, 2023

Question:

What are the CMS documentation requirements for polysomnography?

Answer:

There are several important details to keep in mind for documentation. An order from the treating provider is required to be available in the chart maintained by the Sleep Center. CMS specifies that the order is to be from the provider who treats the patient for all diagnostic tests, including polysomnography. Polysomnography providers must enter the ordering provider’s name and NPI on the polysomnography claim. During a pre-payment audit or post-payment audit, a payer will compare the claim to the order. CMS states that coverage of polysomnography applies only if the patient has documented symptoms, complaints of narcolepsy, sleep apnea, impotence, or parasomnia. This information must be documented in the patient’s medical record. CMS does not provide coverage of polysomnography for chronic insomnia.

This question was answered in our annual Respiratory Therapy Reimbursement & Compliance Update webcast. For more hot topics relating to respiratory services, please visit our store or call us at 1.800.252.1578, ext. 2.