CPT Knowledgebase - Jun 15, 2015
Recently we have been receiving claims for sleep studies in which the coding appears redundant. In our effort to ensure correct payment, please address the following issues relative to sleep studies. It is our understanding that the EEG codes 95819, 95822, and 95816 are subsets of the global polysomnography testing codes 95808 (REVISED IN 2013), 95810 (REVISED IN 2013), and 95811 (REVISED IN 2013) and should not be billed together on the same date of service. Is this a correct interpretation? The Sleep codes 95808, 95810, and 95807 have been billed on the same date of service. It is our understanding that 95810 is inclusive of the codes 95808 or 95807 and should not be billed together. Is our understanding accurate?We have noted the use of modifiers and technical components along with global codes for a simple sleep study performed on the same day of service. It is our understanding that the TC and 26 modifiers are components of a global code. Thus, one can be paid a global charge (if performing both the technical and professional components) or report the appropriate component if that is all that entity performed. We are unfamiliar with the contention offered by this provider that they are entitled to the technical and professional component in addition to billing the global (eg, 95810, 95810 26, and 95810 TC). Are there circumstances whereby this type of billing would be warranted?To view the Official AMA answer and 1000s more like this:
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