Sleep Study Coding Services

Sleep study laboratories across the US have been dealing with a complex medical coding scenario with the introduction of ICD 10 and ever stricter regulations. Value based care and the introduction of home sleep apnea testing (HSAT) to curb costs has halted the growth of many labs. This is why sleep study practices are increasingly taking the help of specialized Sleep Study coding services.

Sleep study coding companies with adequate domain experience have become crucial for labs and ordering physicians in bringing about positive patient outcomes. For the healthcare system and sleep specialists, laboratory-based testing is highly efficient, providing accurate diagnoses, substantial revenue, and profitable growth. But ensuring proper payment needs accurate medical coding with correct modifier usage and continuous attention to regulatory churn.

Let us talk about the complexities in medical coding that these labs face and how our dedicated sleep study coding support solves these issues

Coding Complexities in Sleep Study tests

Billing and coding for sleep study medicine is a much more complicated process than for almost any other medical niche. ICD-10 codes for sleep disorders and CPT codes for sleep study tests are not the only considerations.


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  • Central disorders of hypersomnolence
  1. Circadian rhythm sleep-wake disorders
  2. Sleep-related movement disorders
  3. Parasomnias
  • Other sleep disorders

The ICSD is divided into 81 diagnostics.

  • Evolving Diagnostic Criteria: Keeping up with updates to sleep disorder diagnostic criteria (e.g., ICSD-3) requires ongoing coder training and adaptation.

2. Ambiguity and Inconsistencies in Coding Guidelines:

  • Unclear Terminology: Certain coding guidelines for sleep studies lack clear definitions, leading to ambiguity and interpretation disparities.
  • Bundled Services: The Centers for Medicare & Medicaid Services (CMS) bundles specific services within sleep studies, requiring precise identification of non-bundled services for separate billing.
  • Variations in Payer Policies: Insurance companies have unique Sleep Study coding and billing policies, adding complexity for laboratories.

3. Documentation Shortcomings and Incomplete Data:

  • Inconsistent Documentation: Variations in physician and technician documentation styles, abbreviations, and terminology can lead to coding errors.
  • Missing Information: Incomplete charts or progress notes can hinder accurate coding, potentially resulting in under-coding or missed reimbursement opportunities.

4. Financial Implications of Coding Errors:

  • Reimbursement Losses: Inaccurate coding can lead to under-reimbursement for sleep studies, impacting the financial viability of centers and labs.
  • Denials and Audits: Sleep study coding errors can trigger claim denials, audits, and potential penalties from payers.
  • Resource Burden: Addressing sleep study coding errors and compliance issues requires additional time and dedicated staff, further impacting financial stability.

5. Limited Access to Specialized Coders and Resources:

  • Scarcity of expert coders: Finding qualified coders specializing in sleep disorders and their specific coding requirements can be difficult.
  • Training and Certification Costs: Investing in specialized coder training and certification can be financially burdensome for sleep study centers and labs.
  • Technology Accessibility: Advanced coding software and data analytics tools for sleep studies might be cost-prohibitive for most facilities.

Now, let us look at why outsourcing to a coding service helps sleep study practices deal with these issues.

Coding Services for Sleep Study Practices

From polysomnography (PSG) to multiple sleep latency tests (MSLT) we help practices get paid quickly and efficiently with zero claim denials. Being well versed in the nuances of sleep study coding and payer requirements means that our services help you avoid the pitfalls of this branch of diagnostic medicine.

  • Medicare pays for polysomnography services under different payment systems, depending on where the services are performed. For polysomnography services performed in most hospital outpatient departments, Medicare pays under the Outpatient Prospective Payment System (PPS). For PSG services performed by nonhospital providers, Medicare pays under the Physician Fee Schedule.
  • CMS contracts with Medicare Administrative Contractors (MAC) to process claims for procedures like PSG.

With two decades of experience in full spectrum RCM support for sleep study medicine, we offer a whole host of services.

  • Expert, certified coders that are specialty-specific and dedicated to your account.
  • An advanced process tailored to your specific needs
  • A workflow management system that tracks every record, code, and status.
  • AI and automated tools to aid compliance and accurate code assignment.
  • Automated charge entry designed to eliminate manual processes and errors.
  • An integrated process to identify documentation issues.
  • Expertise in all aspects of the revenue cycle for sleep study labs.
  • Dedicated account manager and custom reports.
  • Complete support with clinical documentation requirements.
  • Services from A/R to Prior Authorization for sleep study.

We cover every diagnostic procedure falling under sleep study including:

  • Coding for pediatric sleep studies
  • Coding for sleep disorders in the elderly
  • Coding for insomnia
  • Coding for sleep apnea
  • Coding for narcolepsy

Partnering with us not only frees up valuable in-house staff or removes the need for extensive paperwork. These are just some of the other benefits we deliver:

  • Reduction in operational cost by 80%
  • Reduction in coding errors and denial rate
  • Complete and customized status tracking

Do not sleep on your coding problems. Schedule a call with our expert today and step into a strategic partnership that will help your lab grow rapidly.

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