Sleep Study Labs Billing & Credentialing
Sleep study labs are a very specialized center for a patient being evaluated for a sleep disorder. The medical billing involved with these labs is also very detailed based on whether the lab is stand-alone or incorporated into a hospital or clinic. The proper use of ICD-10 coding is very important in getting reimbursed for these locations as well as knowing when codes are considered a “bundled” service.
Hospitals
Hospital-Based
A hospital-based sleep lab is the most common location for patients to be evaluated for a sleep disorder. The assessment and management of a patient at this location type can be done 2 ways:
- 94660 – CPAP Initiation and Maintenance (patient must already be under a physicians care)
- G0463 – Assessment and Management of a patient in an Outpatient Hospital Setting
Coding
E/M coding
The use of E/M coding is important in establishing these patients. Follow up visits as well as conveying observation and findings also use these codes whether direct from the physician or as “incident to” services through another healthcare provider.
| CPT Location | Physicians | Obligations |
|---|---|---|
| 99211 | Clinic Physician | Must be in building |
| 99212 | Clinic Physician | Must be in building |
| 99213 | Clinic Physician | Must be in building |
| 99214 | Clinic Physician | Must be in building |
| 99215 | Clinic Physician | Must be in building |
| 94660 | Sleep Center | Physician may need to be present at least 40 minutes |
| G0463 | Sleep Center | Physician does not need to be present |
| 99090 | Either | MD must read and review |
| 99091 | Either | MD time exceeds >30 minutes (not commonly used) |
| 95807-52 | Either | Interpretation of the study |
| 98960-98962 | Either | Physician not required to be present, but should order |
Medwave are up-to-date on the most current use of CPT codes, modifiers, ICD-10 coding and medical documentation. We educate you and your staff on the issues that affect your office the most so that we can work together to make your practice successful.
Outsourcing your medical billing to dedicated professionals can take the stress out of bringing in consistent, reliable money for your practice.
Contact us today to speak with someone on how we can be an affordable asset to you and your sleep study lab’s future in the Greater Pittsburgh region.