What is a CPT-4 code?
The CPT-4 is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals.
What are the two levels of HCPCS?
The Healthcare Common procedure Coding System (HCPCS) is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Questions on the Use of Level I HCPCS Level I of the HCPCS is comprised of Current Procedural Terminology (CPT-4), a numeric coding system maintained by the American Medical Association (AMA).
Do Medicare providers and beneficiaries require an ABN?
Providers and beneficiaries may ask Medicare contractors about coverage for services that require an ABN. A MAC must provide a written notice within: Nice work! You just studied 25 terms! Now up your study game with Learn mode. THIS SET IS OFTEN IN FOLDERS WITH... AAPC Coding Chapter 2 -- Anatomy Review. YOU MIGHT ALSO LIKE...
What is the AHA Coding clearinghouse?
The American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS) have joined together in establishing the AHA clearinghouse to handle coding questions on established HCPCS usage. The American Health Information Management (AHIMA) also provides input through the Editorial Advisory Board.
What is the CPT code for Pap nap?
The PAP-NAP, utilizing CPT code 95807–52 as an abbreviated study, would be a reimbursable procedure.
What is the procedure code for a sleep study?
CPT/HCPCS Codes Unattended sleep studies: 95800, 95801, 95806 (Facility) and G0398, G0399, and G0400 (Home).
What is the CPT code for split night sleep study?
Providers bill for both full-night titration services and split-night services using CPT code 95811. See Table 1 for a description of each type of polysomnography service and associated CPT codes.
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 the diagnosis code for sleep apnea?
Code G47. 33 is the diagnosis code used for Obstructive Sleep Apnea. It is a sleep disorder characterized by pauses in breathing or instances of shallow breathing during sleep.
What is the ICD 10 code for sleep apnea?
G47. 30 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
What is the difference between 95806 and G0399?
CPT® code 95806 Generally, for Medicare, the G0399 code is reported when services are performed in the home, and 95806 is reported when services are performed in a facility. An HST provider should contact each payer to identify which codes to report. Verification is always the responsibility of the provider.
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 included in CPT 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 procedure code 95800?
CPT Code 95800 Sleep study, unattended, simultaneous recording: heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time.
Who can Bill 95800?
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 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.
General Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
An abbreviated daytime sleep study (PAP NAP) has been used by some to address poor compliance and enhance individual comfort and tolerance of CPAP/BiPAP. PAP NAP combines psychological and physiological treatments into one procedure during an abbreviated daytime nap session (100-120 minutes).
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What are the HCPCS codes?
Level II HCPCS codes for hospitals, physicians and other health professionals who bill Medicare#N#A-codes for ambulance services and radiopharmaceuticals#N#C-codes#N#G-codes#N#J-codes, and#N#Q-codes (other than Q0163 through Q0181) 1 A-codes for ambulance services and radiopharmaceuticals 2 C-codes 3 G-codes 4 J-codes, and 5 Q-codes (other than Q0163 through Q0181)
Why do Medicare and other insurers use level II HCPCS codes?
Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT-4 codes, the level II HCPCS codes were established for submitting claims for these items.
What is CPT 4?
The CPT-4 is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals.
What is level 2 of HCPCS?
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT-4 codes , such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover ...
What is Medicare Coverage Database?
Used by Medicare administrative contractors, providers, and other healthcare industry professionals to determine whether a procedure or service is reasonable and necessary for the diagnosis or treatment of an illness or injury; contains national coverage determinations ...
What is medical managed?
Medical Managed. A particular diagnosis (e.g., hypertension) may not receive direct treatment during an office visit, but the provider has to consider that diagnosis when considering treatment for other conditions. Medicare Coverage Database. Used by Medicare administrative contractors, providers, and other healthcare industry professionals ...
What is a 37) form?
Terms in this set (37) is a form that a patient signs and is responsible for paying the bill if the Medicare denies the claim. Medicare patients need to sign this when it is felt Medicare may not pay for the service and the patient would be responsible for the bill.
How to look up CPT code?
steps to do in looking up a code. 1. read the introduction in the CPT coding manual. 2.review guidelines at the beginning of each section. 3. review the procedure or service listed in the source document. 4. refer to the CPT index, and locate the main term for the procedure. 5. locate subterms and follow cross-references.
What is coding procedure?
Coding procedures and services. Coding procedures and services. 1. review the procedure or service listed in the source document. 2. main terms can be located by referring to the a. procedure or services documented. b. organ or anatomic state. c. condition documented in the record.
What is a PAP nap?
The “PAP-NAP” is a daytime sleep study conducted to desensitize patients to PAP therapy , especially patients who have acute anxiety about using PAP due to insomnia or other anxiety conditions.
Why is PAP-NAP considered investigative?
Use of an abbreviated daytime sleep study (eg, PAP-NAP) as a supplement to standard sleep studies is considered investigative due to a lack of evidence demonstrating improved health outcomes. BCBS Tennessee.
What is the CPT code for sleep study?
In his 2008 article, Krakow concluded that the PAP-NAP procedure meets criteria for sleep study CPT code 95807 because PAP-NAPs use four or more sensors, including simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, and are attended by a technologist. Ever since, providers have used this code and ...
What is CPT code 95807?
But as stated by the American Academy of Sleep Medicine (AASM), CPT code 95807 only approximately reflects the service that is being performed with a PAP-NAP. 3 Further, the short duration of the PAP-NAP session makes CPT code 95807 standing alone a loose fit. Medicare reimbursement guidelines contemplate 6 hours of recorded data for sleep studies.
How long does a PAP-NAP last?
Medicare reimbursement guidelines contemplate 6 hours of recorded data for sleep studies. PAP-NAPs are intended to end before all 6 hours of the study’s data are recorded. Providers performing PAP-NAPs address the shortened duration of the study by using “Modifier -52” when billing the 98507 test.
Is PAP NAP easy?
As more sleep centers look for ways to grow their offerings, the PAP-NAP comes to mind as a service that can give labs and physicians a competitive edge. A healthcare lawyer explains how to approach its reimbursement. Nobody said PAP therapy was easy. There’s the mask, the headgear, the hoses, and the forced air—it’s like wrestling ...
Is PAP NAP coverage uniform?
Coverage of the service by commercial carriers is less uniform. Commercial payors are beginning to recognize the specific service of “PAP-NAPs.”. Unfortunately, those that have looked at and described the service in their medical policies have denied coverage as being investigational.