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Accurate Split Night Claims

October 4th, 2011

Neurology & Pain Management Coding Alert: Accurate Split Night Claims

Split Study: Confirm Test Details and Sleep Parameters

A split night sleep study certainly is one method for physicians to diagnose and start providing treatment to a patient’s sleep problem in the same night. It is important that you meet certain criteria prior to reporting the study. Read this neurology billing and coding expert insight on how to ensure flawless split night claims.

During a split night study, normally the patient comes in and begins the test. In case moderate or severe sleep apnea is found or strongly suspected in the first part of the night’s study, the second half of the night can be used to define the required CPAP pressure to relieve the patient’s apnea.

The patient must meet the protocol for the technician to use a CPAP while there’s still sufficient time to titrate the proper levels for the patient. 1

Ensure that you have clear documentation of the patient’s improvement toward meeting protocol prior to assuming it is right to report a split night study. Test documentation should include adequate information to show the seriousness of the patient’s sleep-disordered breathing as well as the physiological effect the sleep-disordered breathing is having on the patient before beginning CPAP therapy. Preferably, the test should document a complete sleep cycle as well as a “worst case scenario” that would have the presence of rapid eye movement (REM) sleep as well as the obstructive sleep apnea (OSA) taking place while the patient is sleeping in the supine position.

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Before assigning your study code, watch out for these additional sleep parameters:
electrocardiogram (ECG)
airflow
ventilation and respiratory effort
gas exchange by oximetry, transcutaneous monitoring, or end tidal gas analysis
extremity muscle activity, motor activity-movement
extended EEG monitoring
penile tumescence
gastroesophageal reflux
continuous blood pressure monitoring
snoring
body positions.

Your challenge: Ensure that your neurologist documents all the essential elements for the additional parameters. You can definitely ease the process by becoming familiar with your physician’s dictation style to confirm you’re coding the proper sleep study.

The presence of one or all of the parameters listed above helps narrow your code choices. CPT® currently includes three diagnostic polysomnography codes:

95808 — Polysomnography; which is sleep staging with 1-3 added parameters of sleep, in the presence of a technologist
95810 — which is sleep staging with 4 or more added parameters of sleep, in the presence of a technologist
95811 — sleep staging with 4 or more added parameters of sleep, with start of nonstop positive airway pressure therapy or bilevel ventilation, in the presence of a technologist.

Remember that in case you’re coding for a split night study, you rare left with only one code choice: 95811. Want to have more neurology billing and coding expert tips and know everything about neurology CPT codes ? Click here to read the entire article and to get access to our monthly Neurology & Pain Management Coding Alert: Your practical adviser for ethically optimizing coding, payment, and efficiency in neurology and pain management practice

Read more to perfect your neurology billing and coding: http://www.supercoder.com/articles/articles-alerts/nca/sleep-studies-confirm-test-details-and-sleep-parameters-before-coding-split-study-106895/

Erin Lang Masercola, PhD, CPC, has been writing about health care law, reimbursement, compliance and HIT for ten years. Most recently, she’s been collaborating with medical coders and software engineers to create an amazing new online coding reference tool called Supercoder.com. She is a certified professional medical coder through AAPC.
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Accurate Split Night Claims