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Here are a few helpful tips when coding for sleep studies, pediatric home apnea monitor recording analysis and pediatric pneumogram circadian recording:
- Sleep study codes 95805-95811 should be used when there is continuous and simultaneous monitoring and recording of various physiological parameters of sleep for six hours or more with physician review, interpretation and reporting.
- Polysomnography is distinguished from sleep studies by the inclusion of sleep staging, which is defined to include a 1-4 lead EEG, an electro-oculogram (EOG) and a submental EMG. To report polysomnography, sleep must be recorded and staged. Sleep staging includes a qualitative and quantitative assessment of sleep and should not be reported together with polysomnography. These codes should not be used when a Holter monitor reading is performed.
- For interpretation only, use modifier 26. (Limits: 95805–3 per year, 95807 and 95810–2 per year)
- Pediatric home apnea monitoring event recording is billed using codes 94774-94777. This study includes respiratory rate, pattern and heart rate per 30-day period of time. The codes describe appropriate services from monitor attachment only to the complete service of attachment, download of data, physician review and preparation of report. As per the code description, these codes should only be reported once per thirty days. Use care when choosing the code that most accurately describes the service provided.
- Circadian respiratory pattern recording (pediatric pneumogram) is coded with 94772. This code is used for infants for a 12-24 hour continuous recording. A pulmonary lab assistant performs pulmonary function testing to measure various aspects of the lungs. A physician interprets the report. A 26 modifier should be used when an independent physician performs the interpretation. Again, this code should not be used when an analysis of a Holter monitor reading is performed.
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