Sleep is essential for both our physical and mental health, but very few seem to realize how important it really is. Health consequences from sleep disorders and tiredness are shocking and it is apparent that there is a significant amount of sleep issues in our society. According to the CDC, 35% of adults don’t get enough sleep (7 hours per day). Not getting enough sleep can lead to sleeping deprivation and related disorders. Occasional sleeping problems might affect some people, but then it is important to find out if it’s just a minor, passing annoyance or a sign of a more serious sleep disorder or underlying medical condition. According to the American Sleep Association (ASA), 50-70 million US adults have a sleep disorder. Sleep medicine physicians treating patients have to maintain accurate documentation regarding the diagnosis and medical services provided. Medical coding for sleep medicine is quite challenging, as there are several rules related to reporting the procedures accurately. Relying on a reliable medical billing company can help in accurate and timely claim submission for appropriate reimbursement.

ICD-10 Diagnostic Codes for Sleep Disorders

  • G47.00: Insomnia (NOS)
  • G47.10: Hypersomnia (NOS)
  • G47.33: Obstructive Sleep Apnea
  • R06.83: Snoring
  • G47.20: Circadian Rhythm Sleep Disorders (NOS)
  • G47.21: Delayed Sleep Phase Type
  • G47.22: Advanced Sleep Phase Type

Procedure Codes for Sleep Medicine

Procedure codes for sleep medicine are contained in the CPT® code range 95803-95783 and HCPCS Level II code range G0398-G0399. Code sets can be categorized further by type:

  1. Miscellaneous sleep diagnostic testing
  2. Home sleep study tests
  3. Sleep studies
  4. Polysomnography
  1. Miscellaneous Sleep Diagnostic Testing: In this type, there are two different tests that can be performed, they are:
    • 95803: Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
    • 95805: Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness

      95803 is a home setting test, where patients are given an actigraph device to wear on the wrist. This device records sleep and movements over 3 to 14 days. Once the device is returned to the provider’s office, the data can be downloaded to a computer and analyzed by specialized software to assist in the evaluation or monitoring of sleep disorders such as circadian rhythm disorders and sleep-disordered breathing.

      The second test, 95805 is a multiple sleep latency test. This testing consists of 4 or 5 short nap opportunities in the office setting that are set a few hours apart. The patient’s brain waves, muscle activity, and eye movements are monitored and recorded during these nap sessions. That data can be used to diagnose narcolepsy and excessive daytime sleepiness, as well as assess the efficacy of treatments for breathing disorders. If fewer than 4 nap opportunities are recorded, append modifier 52 for Reduced services.

  1. Home Sleep Studies: This is a cost-effective test that is performed at the patient’s home. A special piece of equipment tracks breathing, oxygen levels, and breathing effort overnight and this data is abstracted from the device and is interpreted with specialized software to diagnose sleep disorders. Generally, there are three HCPCS Level II codes to report home sleep study tests, with the differentiating factor being the number of channels used during recording:

    • G0398: Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
    • G0399: Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
    • G0400: Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels
    • CPT® code range 95806-95783 contains codes for all in-office/hospital sleep studies. These are either sleep studies or Polysomnographies (specialized sleep studies).

      For instance,

    • 95806: Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)
    • 95807: Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
    • 95808: Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist
    • 95810: Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
  1. Sleep Studies (Non-polysomnographic): These sleep studies are further categorized into two types: attended or unattended.

    Only one CPT® code for an attended, non-polysomnographic sleep study

    • 95807: Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
    • Unattended, non-polysomnographic sleep studies are reported using three CPT® codes:

    • 95806: Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)
    • 95800: Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time
    • 95801: Minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone)
  1. Polysomnography: Special types of in-office/hospital, attended sleep studies that record brain waves, blood oxygen levels, heart rate, breathing, eye movements, and leg movements. This test can either be purely diagnostic, therapeutic, or “split.”

    The three codes for Purely Diagnostic Polysomnography are:

    • 95808: Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist
    • 95810: Age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
    • 95782: Younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist

    For patients with a diagnosis such as sleep apnea, Therapeutic and Split Polysomnography can be used, because its purpose is to determine what titration levels of therapies, such as continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP), are required to treat the patient’s apnea.

    Two codes are used to report therapeutic and split Polysomnography:

    • 95811: Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist
    • 95783: Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist

According to the American Academy of Sleep Medicine (AASM), to report apolysomnography (PSG) and home sleep apnea test (HSAT), there has to be continuous & simultaneous monitoring & recording of various physiological & pathophysiological parameters of sleep for 6 or more hours. Similarly, for codes 95782 and 95783 (pediatric polysomnography and PAP titration) a minimum of 7 or more hours of monitoring and recording is required. The reduced services modifier, modifier 52, must be used in cases involving less than 6 hours recording time in patients ages 6 and older and in cases involving less than 7 hours recording time in patients under age 6.

With all the challenges involved, the best option for sleep medicine physicians is to rely on specialized outsourced medical billing services for timely and accurate claim submission. Expert teams in an established outsourcing company can handle all the billing and coding challenges competently and help healthcare providers maximize their revenue and improve patient care.