Know About the Frequently Used on Codes in Sleep Study Billing Services

Obstructive sleep apnea (OSA) is when your patient’s breathing stops and starts while they sleep. As a sleep study specialist you often treat people who are suffering from obstructive sleep apnea. To figure out if your patient has it, they might come to your sleep lab or take a test at home. The American Academy of Sleep Medicine has a new rule for testing OSA. And if you are a sleep doctor, keeping up with these new guidelines is super important to help you catch OSA and make sure sleep study billing services get done right for your care.

The truth is obstructive sleep apnea affects about 30 million adults in the U.S. When OSA isn’t treated, it can lead to severe problems like high blood pressure and heart disease. The American Academy of Sleep Medicine made a new guideline for testing sleep apnea in adults—it enables you to provide the best course of treatment for your patients suffering from OSA.

It is really important for you to know the recently updated practice recommendation for diagnosing OSA-

A group of sleep doctors came together to make a new guideline for diagnosing OSA. They found two important tips to help you provide the perfect care for your patients suffering from OSA:

• When you conduct a diagnostic test for obstructive sleep apnea, you must do it with the thorough sleep evaluation and proper follow-up
• You must perform polysomnography for adult patients after completing the thorough sleep evaluation

The experts found that home tests for sleep apnea don’t always work well for people with other health problems. So, besides the best practices, the American Academy of Sleep Medicine (AASM) has come up with the following recommendations for diagnosing sleep apnea (OSA) in adults:

• You should never use any tool without performing polysomnography
• You must go for testing for patients who have moderate to severe OSA
• You should go for polysomnography if you find a patient’s single test result is negative
• If your patient has certain health issues—like serious heart or lung disease, weak breathing muscles from a neuromuscular problem, low oxygen levels when they are awake, or if they are on strong pain meds, had a stroke, or have really bad insomnia—then you should perform a specific sleep study called polysomnography.

Apart from the clinical care, one thing that you cannot overlook is the administrative side of your practice as your financial-base majorly relies on your sleep study billing service and this is where coding plays a vital role. A single mistake in your sleep study coding process can lead your practice to encounter claim denials, payment delays and revenue loss.

You must know about the recently updated ICD-10, CPT and HCPCS codes for sleep-related breathing disorders to make your sleep study billing system perfect.

ICD-10 codes for sleep-related billing disorders-

• G47.33 stands for Obstructive Sleep Apnea. It falls under these Diagnosis Groups:
• 011: Tracheostomy for face, mouth, and neck with major complications
• 012: Tracheostomy for face, mouth, and neck with complications
• 013: Tracheostomy for face, mouth, and neck without complications
• 154: Other ear, nose, mouth, and throat diagnoses with major complications
• 155: Other ear, nose, mouth, and throat diagnoses with complications
• 156: Other ear, nose, mouth, and throat diagnoses without complications

CPT codes for diagnosing OSA-

• 95783: Polysomnography for kids under 6 with 4+ sleep measures, starting CPAP or bilevel therapy, with a technologist present.
• 95800: Unattended sleep study that records heart rate, oxygen levels, breathing, and sleep time.
• 95801: Unattended sleep study that records at least heart rate, oxygen levels, and breathing.
• 95803: Actigraphy test that tracks sleep activity, recorded for 3 to 14 days, with full analysis and report.
• 95805: Test for sleepiness (like a nap test), measuring sleep over multiple trials.
• 95806: Unattended sleep study that records heart rate, oxygen levels, airflow, and breathing effort.
• 95807: Sleep study with a technologist, tracking ventilation, breathing effort, heart rate, and oxygen levels.
• 95808: Polysomnography with 1-3 sleep measures, with a technologist present.
• 95810: Polysomnography with 4+ sleep measures, with a technologist present.
• 95811: Polysomnography with 4+ sleep measures, starting CPAP or bilevel therapy, with a technologist present.

Sleep study billing services can be a bit tricky as you have to deal with different codes for procedures, diagnoses, and measurements. Sleep clinics need to stay updated on what insurance will and won’t pay, and they also have to work with many people—like DME providers, patients, and insurance companies—to make sure billing is done right. This can lead to mistakes, causing extra costs, more denials, and lower payments.

That’s why a lot of sleep clinics are now outsourcing their sleep study billing services. Sunknowledge Services Inc. is one trusted company that’s been helping sleep clinics get accurate billing for almost 20 years with HIPAA-compliant sleep study billing services!

Don’t ignore your billing and coding issues! Schedule a call with our expert today and start a partnership that will help your lab grow fast.