Basics of CPT code for Sleep study

Today we will learn about CPT code for Sleep Study. We have different set of procedure codes for coding these sleep study procedures. We have even HCPCS codes as well for coding these exams. Depending on the payer’s requirement we have to use HCPCS codes.

Earlier we have learnt about coding wound debridement procedures, angiography procedures, lysis of adhesion coding etc. All these procedures are little tricky to learn. But, with continuous use of these procedures codes you can become familiar with these codes.

Today, also we will see similar set of CPT code for sleep study which are used in procedure coding.

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Description for CPT code for Sleep study

CPT code 95806, 95800, 95801 and 95807 are the main procedure codes used for coding Sleep study. Below is the detail description of these medical codes.

Unattended sleep studies are used by physicians in the diagnosis of certain patients with suspected sleep disorders. Without the attendance of a technologist, the test is performed with a portable recording device. Oxygen saturation and cardiorespiratory measurements, including heart rate, respiratory airflow, and respiratory effort (thoracoabdominal movement) are simultaneously recorded during the test reported by CPT code 95806.

CPT code 95801 is reported for an unattended sleep study that measures a minimum of heart rate, oxygen saturation, and respiratory analysis by airflow or peripheral arterial tone, and CPT code 95800 if these measurements also include sleep time. A physician interprets the results.

95806  Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)

95800 Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time

95801 minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone)

95807 Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist

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Polysomnography or CPT code for Sleep Study

Polysomnography is the most commonly used test in the diagnosis of Obstructive Sleep Apnea Syndrome (OSAS). It helps in determining the severity of the disease.  Polysomnography consists of a simultaneous recording of multiple physiologic parameters related to sleep and wakefulness. We have CPT or procedures codes based on number of parameters. Below you can see the different in CPT codes on number of parameters of sleep.

Physiological parameters of a pediatric patient asleep in a lab setting are monitored for a minimum of six hours of polysomnography studies in patients 6 years and older or seven hours for patients younger than 6 years. The pediatric patient is attended by a technologist (CPT code 95810, 95782, respectively) and may require the initiation of continuous positive airway pressure (CPAP) therapy or bilevel ventilation during the study (CPT code 95811, 95783, respectively).

In contrast to sleep studies, polysomnography details measurements such as sleep staging with electroencephalogram (EEG), electrooculogram, and submental electromyogram. These codes include sleep staging with four or more additional measurements, such as respiration, airflow, oximetry, muscle activity, vital signs, and snoring.

95808 Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist

95810 age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist

95811 age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist

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

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

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HCPCS code for Home Sleep Study

Some Medicare contractors and commercial payors will mandate the use of G-codes and will not accept CPT codes when reporting Home Sleep Apnea Testing (HSAT). Be certain to understand the carrier’s requirement when submitting the claim. 

G0398: Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation

G0399: Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation

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ICD 10 Codes related to Sleep Study or Polysomnography

Diagnosis codes are very important for sleep study CPT codes. If the ICD 10 codes does not fulfills the medical necessity for procedures codes for sleep study, the CPT codes or exam performed will not be paid by the insurance companies. The most common ICD 10 codes used for sleep study are given below.

G47.33                        Obstructive sleep apnea

G47.36                        Sleep-related hypoventilation/hypoxemia in conditions classified elsewhere

G47.01 and G47.33 Insomnia with sleep apnea, unspecified

G47.14 and G47.33 Hypersomnia with sleep apnea, unspecified

G47.30                        Unspecified sleep apnea

Conclusion

Hope, now you know all the CPT codes used for coding Sleep Study test. Please do share your thoughts in comment sections.