Full Answer
What is a PAP-nap?
A PAP-NAP is a short daytime encounter that is designed to help the patient adjust to CPAP treatment. It will help your patients with their therapy compliance as well as assuring their full understanding of CPAP treatment and benefits.
What is the primary payer code for medical billing?
Primary Payer Code = E. If filing for a Conditional Payment, report with Occurrence Code 24. Public health services (PHS) or other federal agency. Conditional billing does not apply. Primary Payer Code = F.
Where can I find a complete set of Medicare codes?
Complete code sets are available through the National Uniform Billing Committee (NUBC) website, www.nubc.org. To navigate directly to a particular type of code, click on the type of code from the following list: Beneficiary's and/or spouse's EGHP is secondary to Medicare.
What is an MSP claim for Medicare Part B?
MSP claim is being filed because claim is an inpatient claim or claim is an outpatient claim and the beneficiary has not yet met his/her annual Medicare Part B deductible. Change to make Medicare the secondary payer (report on adjustment when original claim was processed as a Medicare primary claim, conditional claim or was rejected for MSP).
How do you code a sleep study?
For a study to be reported as polysomnography (PSG), sleep must be recorded and staged and directly attended by a qualified technologist. Report with modifier 52 if less than 6 hours of recording or in other cases of reduced services. CPT codes 95782, 95783, 95808, 95810, and 95811 include sleep staging.
What does CPT code 95807 mean?
95807. Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist.
What is the CPT code for polysomnography?
Providers bill for polysomnography services using three CPT codes. Providers bill for diagnostic services using either CPT code 95808 or 95810, depending on how many parameters of sleep are measured. Providers bill for both full-night titration services and split-night services using CPT code 95811.
What is the CPT code for split-night sleep study?
CPT® code 95811, the code used to bill a split-night study, does not specify a required number of diagnostic hours and titration hours. The AASM clinical practice guideline on diagnostic testing for adult OSA recommends a minimum of two hours of diagnostic recording and three hours of recording for CPAP titration.
What is the difference between 95800 and 95806?
Reporting 95800 includes a measurement of sleep time and 95806 describes a measurement of respiratory airflow and effort.
What is procedure code 94660?
CPT code 94660 is a face-to-face service addressing the use of CPAP for sleep-disordered breathing, such as (but not limited to) obstructive sleep apnea. This may often be performed in a sleep testing laboratory.
What is code 95811?
A: CPT® code 95811 (Polysomnography; 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) should be used for polysomnography with CPAP.
What does CPT code 99242 mean?
CPT® Code 99242 - New or Established Patient Office or Other Outpatient Consultation Services - Codify by AAPC. CPT. Evaluation and Management Services. Consultation Services. Office or Other Outpatient Consultation Services.
What is procedure code 95816?
95816. ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND DROWSY. 95819. ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND ASLEEP.
What is procedure code e0601?
Short Description: Cont airway pressure device. Long Description: CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE.
Is CPT 95800 a home sleep study?
CPT®/HCPCS code requirements may vary by payer for unattended home sleep studies. Most private payers accept CPT® 95800 for the WatchPAT™ sleep test. Some Medicare contractors accept CPT® 95800 while others require reporting with HCPCS G0400.
What diagnosis will cover a sleep study?
Medicare covers sleep studies when the test is ordered by your doctor to diagnose certain conditions, including sleep apnea, narcolepsy and parasomnia. Sleep studies can take place at a sleep clinic or in your home. Medicare Part B covers 80 percent of the cost for sleep studies.
What is PAP NAP desensitization?
Another private payer, Premera, states in its policy, “the daytime PAP-NAP desensitization procedure is considered investigational to help patients with insomnia/panic attacks/claustrophobia overcome anxiety about the mask and pressure sensations of the PAP device.”.
Is PapNap considered investigational?
For example, Blue Cross® Blue Shield® (BCBS) of Alabama states, “for dates of service on or after June 13, 2013: the use of an abbreviated daytime sleep study (PapNap) as a supplement to standard sleep studies does not meet Blue Cross Blue Shield of Alabama’s medical criteria for coverage and is considered investigational.”.
Is PapNaps an investigative measure?
BCBS of Minnesota came to the same conclusion, stating that PapNaps are considered to be “investigative due to lack of evidence demonstrating improved health outcomes.”. The same language can be found in BCBS policies in other states, such as Tennessee.
What is HIPAA standard?
HIPAA directed the Secretary of HHS to adopt national standards for electronic transactions. These standard transactions require all health plans and providers to use standard code sets to populate data elements in each transaction.
What is a place of service code?
Place of Service Codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the health care industry.
What is an EGHP?
EGHP is a multi- or multiple-employer plan that elects to pay secondary to Medicare for employees and spouses aged 65 and older for those participating employers who have fewer than 20 employees. 29. Disabled beneficiary and/or family member's LGHP is secondary to Medicare.
Is EGHP secondary to Medicare?
To navigate directly to a particular type of code, click on the type of code from the following list: Beneficiary's and/or spouse's EGHP is secondary to Medicare. Beneficiary and/or spouse are employed and there is an EGHP that covers beneficiary but either:
Is EGHP a Medicare plan?
Beneficiary's and/or spouse's EGHP is secondary to Medicare. Beneficiary and/or spouse are employed and there is an EGHP that covers beneficiary but either: EGHP is a single employer plan and employer has fewer than 20 full- and/or part-time employees.
