Question: A sleep study was ordered for a patient diagnosed with hypersomnolence. The neurologist included a multiple wake test in the sleep study. What CPT code should I use for the multiple wake test?
Answer: You should use 95805 (Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness). Code 95805 is the only sleep study code (95803-95811) that mentionswakefulness testing. Check if you need a modifier on 95805.
Sleep services codes (95805-95811) include recording, interpretation, and report. For cases when the neurologist does only the interpretation, use modifier 26 (Professional component) on the sleep study code.
All sleep studies must have a minimum of six hours. If the sleep study does not last that long, append modifier 52 (Reduced services) to your code.
The multiple wake test measures the patient’s ability to stay awake during a time when she is normally awake. During the wakefulness test the physician or technologist records the time it takes the patient to fall asleep during a course of four to five 20-minute nap opportunities provided during the testing period in the sleep lab.
The patient does not need to be asleep during the tests.
© Neurology Coding & Reimbursement. Download your 2 free sample issues here.
Related articles:
- Protect Sleep Study Pay With These Documentation Essentials How to keep your polysomnography claims off Medicare’s hit…
- Sleep Study Reimbursement: How to Claim Your Piece of the Pie Medicare promises to cover facility and home-based testing —…
- CMS: Apnea is Key for Sleep Testing Coverage Medicare benes who suffer from obstructive sleep apnea (OSA)…