FIRST
COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES
Contractor’s
Determination Number
95805
Contractor Name
First Coast Service
Options, Inc.
Contractor’s
Determination Number
09102 –
09202 – Puerto Rico
09302 –
LCD Title
Polysomnography and
Sleep Studies
Coding
Guidelines
·
For a study to be reported as polysomnography (PSG), sleep must be
recorded and staged and directly attended by a qualified technologist. Report with modifier 52 if less than 6 hours
of recording or in other cases of reduced services.
·
CPT codes 95808, 95810, and 95811 include sleep staging. Medicare would not expect to see separate
billings for an EEG, EOG, and/or EMG in addition to these codes.
·
CPT code 95808 includes reimbursement for one to three additional
parameters. CPT codes 95810 and 95811
include four or more additional parameters.
Therefore, Medicare would not expect to see separate billings for additional
parameters in addition to codes 95808, 95810, or 95811. Additional parameters
of sleep include:
o
ECG
o
Airflow
o
Ventilation and respiratory effort
o
Gas exchange by oximetry, transcutaneous monitoring or end tidal gas
analysis
o
Extremity muscle activity and motor activity movement
o
Extended EEG monitoring
o
Penile tumescence
o
Gastroesophageal reflux
o
Continuous blood pressure monitoring
o
Snoring
o
Body positions
Other Comments
N/A
Revision History
|
Date |
Revision |
|
06/30/2009 |
Original |
Document formatted:
04/09/2009 (DA/st)