Home Sleep Apnea Testing – Why Reliable Medical Billing and Coding Services are Crucial

by Outsource Strategies International Medical Billing Company To diagnose obstructive sleep apnea (OSA) – the sleep-related breathing disorder that causes breathing to repeatedly stop and start during sleep – physicians order a home sleep test or ‘Sleep Study’ for patients suspected of having the condition. As HSAT is performed outside of the sleep lab, it costs less than a laboratory sleep test.

Now an integral part of clinical practice, home sleep apnea testing (HSAT) is on the rise. However, coding and billing for HSAT is quite complex as it requires having comprehensive knowledge about various aspects. Therefore, physicians ordering the test and interpreting the results require expert medical billing and coding services to ensure the accuracy needed for appropriate reimbursement.
 
Home Testing for Sleep Apnea

Conducted using special portable device, a home sleep test assesses nasal and oral airflow, respiratory effort and oxygen levels in the blood during sleep. The patient applies the device’s sensors to the body and sleeps with the equipment for 1–3 nights. The diagnostic service company that provides the device downloads the data and processes it for interpretation by the sleep physician. The latter has to interpret the data and produce a diagnostic report using the right codes. This is sent back to the treating physician who ordered the home sleep test and discusses the results.

Why Professional Medical Coding Service is Critical for Sleep Physicians

The following conditions increase the complexity of HSAT billing and coding:

- Use of HSAT as a first line diagnostic test by insurance companies has increased
- Different insurers accept different codes for HSAT
- Payers change policies quite frequently and coverage may vary by region

Professional medical billing and coding companies have experts on the job who are knowledgeable about all the aspects required to ensure accurate coding for proper reimbursement.

* Type of HSAT device used: Knowledge about the latest classification of portable monitoring used by CMS is crucial. HSAT devices differ in the way they measure/estimate sleep time. Some devices measure sleep  using one or more EEG leads and may include sleep staging, while others measure sleep time using sleep surrogates such as actigraphy. CMS established G codes in 2008 to classify sleep tests and uses the physiologic parameters monitored to classify the type of HSAT device used. The descriptors of the G codes are as follows:

- G0398 – HST with Type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
- G0399 – HST with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation
- G0400 – HST with type IV portable monitor, unattended; minimum of 3 channels

* Use of correct CPT and/or HCPCS codes:  Trained medical coders would know that while some insurers accept the G codes, others accept the CPT codes 95800, 95801 and 95806 for HSAT. They would also be aware about the Current Procedural Terminology (CPT) codes that describe sleep testing procedures which are in the series between 95800 and 95811, 95782, and 95783.

Some insurers accept both the G codes and the CPT codes. Therefore, to ensure proper medical billing practices, the medical coding company contacts each insurer to identify the correct codes to report.

* Use of corresponding ICD-10 codes: In addition to using the right CPT codes, expert coders would also use the right ICD-10 codes for sleep disorder diagnosis. Some examples: G47.00 – adjustment insomnia – F-51.02, Insufficient sleep syndrome – F51.12, and Opioid dependence with opioid-induced sleep disorder - F11.282.

* Knowledge about payer guidelines and policies: Experienced medical coders would visit CMS and commercial payer websites to obtain critical information:

- Payer guidelines on indications for sleep testing, types of HSAT devices approved for use, and number of nights of HSAT testing permitted per billing procedure
- Reimbursement rates
- CMS local coverage determinations
- Specific insurance policy rules on matters such as whether HSAT accreditation is required for reimbursement, and whether the HSAT physician who interprets the results must be board certified in sleep medicine

Professional medical billing and coding services would include obtaining prior authorization for HSAT testing from insurance companies when required.

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Created on Dec 31st 1969 18:00. Viewed 0 times.

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