1. Sleep Study Center Snayhil Rana

2. Sleep : An Overview What is Sleep ? Sleep is a naturally recurring state Characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of nearly all voluntary muscles. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, but it is more easily reversible than hibernation or coma. Sleep is a heightened anabolic state, accentuating the growth and rejuvenation of the immune, nervous, skeletal and muscular systems.

4. Sleep Study : Human Biological Clock

5. Sleep Study What is Sleep study ? Sleep studies allow doctors to measure how much and how well you sleep. They also help show whether you have sleep problems and how severe they are. Sleep studies are important because untreated sleep disorders can increase your risk of high blood pressure, heart attack, stroke, and other medical conditions. Sleep disorders also have been linked to an increased risk of injury due to falls and car accidents. People usually aren't aware of their breathing and movements while sleeping. They may never think to talk to their doctors about sleep- and health-related issues that may be linked to sleep problems.

6. Sleep Study : Polysomnogram What happens at the Sleep Lab? The sleep unit consists of several private bedrooms outfitted with simple non-invasive monitoring equipment used to monitor brain, muscle, heart and breathing activity during sleep. Prior to sleep, the staff will attach several monitoring leads to you, then work through the night in an adjacent room to observe the recordings. Some of the activities of the body monitored during a sleep study usually include the following: Brain activity (electroencephalogram, EEG) Muscle activity (electromyogram, EMG) Heart activity (electrocardiogram, ECG) Eye activity (electrooculogram, EOG) Chest and stomach movements Airflow at nose and/or mouth Body oxygen level (light transmission through finger/ear-lobe) Sleeping position.

7. Sleep Study : Polysomnogram Polysomnogram (PSG) A PSG usually is done while you stay overnight at a sleep center. A PSG records brain activity, eye movements, heart rate, and blood pressure. A PSG also records the amount of oxygen in your blood, how much air is moving through your nose while you breathe, snoring, and chest movements. The chest movements show whether you're making an effort to breathe. PSG results are used to help diagnose: ● Sleep-related breathing disorders (such as sleep apnea). ● Narcolepsy (PSG and MSLT results will be reviewed together). ● Sleep-related seizure disorders.

8. Sleep Study : Polysomnogram

9. Sleep Study : MSLT & MWT What happens after sleep study? Your sleep study will be read by a sleep specialist and a final report will be sent to your healthcare provider after the study. You should schedule a follow-up visit with your healthcare provider to discuss the results of your study and any treatment that is needed. If the sleep study shows that you do need additional treatment, your healthcare provider will order the equipment you may need, arrange training on how to use the equipment, and schedule any more tests that may be needed.

10. Sleep Study : Sleep Disorder Sleep Disorders At least 40 million Americans each year suffer from chronic, long-term sleep disorders each year, and an additional 20 million experience occasional sleeping problems. These disorders and the resulting sleep deprivation interfere with work, driving, and social activities. They also account for an estimated $16 billion in medical costs each year, while the indirect costs due to lost productivity and other factors are probably much greater. Doctors have described more than 70 sleep disorders, most of which can be managed effectively once they are correctly diagnosed. The most common sleep disorders include insomnia, sleep apnea, restless legs syndrome, and narcolepsy. Insomnia Sleep Apnea Restless Legs Syndrome Narcolepsy

11. Sleep Study : CPT Coding

12. CPT Code 95800 Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time. Fee for Services - $ 205.56 CPT Code 95801 Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone). Fee for Services - $ 96.83 CPT Code 95803 Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording) Fee for Services - $162.41

13. Sleep Study : CPT Coding CPT Code 95805 Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness. Fee for Services - $410.43 CPT Code 95806 Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoraco – abdominal movement). Fee for Services - $182.11 CPT Code 95807 Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist. Fee for Services - $469.89

14. Sleep Study : CPT Coding CPT Code 95808 Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist. Fee for Services - $649.63 CPT Code 95810 Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist. Fee for Services - $694.14 CPT Code 95811 Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist. Fee for Services - $749.18

15. Sleep Study : CPT Coding Medical Coding Guideline ► Do not report 95800 in conjunction with 93041-93227, 93228, 93229, 93268-93272, 95803, 95806, 95801. ► For unattended sleep study that measures a minimum of heart rate, oxygen saturation, and respiratory analysis, use 95801. ► Neurologic services are typically consultative, and any of the levels of consultation (99241- 99255) may be appropriate. In addition, services and skills outlined under Evaluation and Management levels of service appropriate to neurologic illnesses should be reported similarly. ► The EEG, autonomic function, evoked potential, reflex tests, EMG, NCV, and MEG services (95812-95829 and 95860-95967) include recording, interpretation by a physician, and report. For interpretation only, use modifier 26. For EMG guidance, see 95873, 95874. ► For repetitive transcranial magnetic stimulation for treatment of clinical depression, see Category III codes 0160T, 0161T ► Do not report codes 95860-95875 in addition to 96000-96004.

16. Sleep Study Medical Billing Guideline: Medical Necessity A physician may recommend a sleep test if the patient has any of the following conditions: ► Sleep apnea: This form of a respiratory dysfunction results in cessation or near cessation of respiration. These cessations of breathing may be due to an occlusion of the airway (i.e., obstructive apnea), an absence of respiratory effort (i.e., central sleep apnea) or a combination of these factors (i.e., mixed sleep apnea). ► Narcolepsy: This condition is characterized by a powerlessness to remain awake during daylight hours even after adequate nighttime sleep. Patients with narcolepsy experience the inability to remain awake at almost any time, and they lack voluntary control of this behavior. ► Parasomnias: This group of behavioral disorders involve brief or partial arousals during sleep, but without marked sleep disruption or impaired daytime alertness. This group of disorders occurs more often in children, but it may persist into adulthood when the occurrence may have more pathologic significance. ► Other sleep disorders: Physicians may order sleep tests for other less common sleep disorders as well. For instance, some patients may require testing for periodic limb movement of sleep (PLMS). PLMS is a condition characterized by sudden jerking leg movements that commonly accompany restless leg syndrome.

17. Sleep Study Medical Billing Guideline: Medical Necessity A physician may recommend a sleep test if the patient has any of the following conditions: ► Obstructive Sleep Apnea Syndrome - 327.23 ► Periodic Limb Movement Disorder - 327.51 ► Central Sleep Apnea Syndrome - 327.21 ► Narcolepsy - 347 ► Insomnia – 327.00 ► Psychophysiological Insomnia – 307.42 ► REM Sleep Behavior Disorder - 307.42 ► Sleep Apnea / Sleep Related Breathing _Disorder, Unspecified - 327.20 ► Sleep Related Bruxism – 327.53 ► Restless Leg Syndrome – 333.94

18. Sleep Study Medical Billing Guideline: Medical Necessity Coders may report polysomnography and sleep studies as a complete procedure, or they may bill separately for the professional and technical components of each. Most third-party payers will only cover one polysomnography or sleep study per date of service by the same or different provider. Additionally, most thirdparty payers will not reimburse for the separately billed technical or professional components of these services on the same date of service that a patient receives a complete polysomnography or sleep study.Oftentimes, the complete procedure occurs as an episode that begins on one date of service and ends on another. When billing for a complete procedure that spans two dates of service, the coder should bill for the day that the procedure began. Coders should not bill the procedure twice, because it occurred over a two-dayperiod.

19. Sleep Study Medical Billing Guideline: Medical Necessity Additionally, Medicaid does separately reimburse for the following procedures on the same date of service when the same or a different provider performs those services: ► Electrocardiographic monitoring for 24 hours (CPT codes 93224–93272) with sleep studies and polysomnography (CPT codes 95805–95811). ► Noninvasive ear or pulse oximetry single or multiple determinations (CPT codes 94760 and 94761) with sleep studies and polysomnography (CPT codes 95805–95811). ► Circadian respiratory pattern recording (e.g., pediatric pneumogram), 12–24 hour, continuous recording, infant (CPT code 94772) with sleep studies (CPT codes 95805–95806). ► CPAP, initiation and management, (CPT code 94660) with polysomnography (CPT code 95811) ► EEG (CPT codes 95812–95827) with polysomnography (CPT codes 95808–95811) ► Facial nerve function studies (CPT code 92516) with polysomnography (CPT codes 95808– 95811).

22. Thanks Snayhil Rana