Medical Billing for Sleep Medicine and CPAP

Medical Billing for Sleep Medicine & CPAP

Sleep Medicine has been an evolving specialty of medicine for years. The reimbursement for studies has fallen considerably, so it is vital to have a medical billing company who knows the ins and outs of sleep medicine billing.

MPMR works with lots of sleep centers, and has experts in medical billing for sleep medicine and CPAP devices. MPMR also assists with credentialing and contracts as well, so there are significant value added services.

Billing for Sleep Medicine Procedures

Sleep Medicine is the area of study of sleep disorders and is a relatively new area of study, and as such, the coding for diagnosing sleep disorders changes almost every year. Under the ICD-10, there are various procedures that fall into the category of sleep medicine.

For instance, if a physician orders a measurement of a patient’s sleep patterns, the billing code would be 4A0ZXQZ. The “4” represents the section of the ICD-10 entitled Measurement and Monitoring. The “A” signifies that the body system is under Physiological Systems. The “0” stands for measurement, and the “Z” represents that there is no specific body part on which the procedure is being performed.

The “X” signifies that the approach to this measurement procedure is an external one, meaning that there are no instances of cutting the skin in order to perform the procedure. The “Q” indicates that there is no permanent or semi-permanent device being used to measure the patient’s sleep.

If there was a situation in which sleep would need to be measured using a device that is left in the body (highly unlikely), then it would be coded differently under the medical and surgical section of coding. The “Z” indicates that there are no other qualifiers for this particular procedure.

CPAP Coding

In many cases, one of the treatments becomes medically necessary in the area of sleep medicine, such as the use of a CPAP. A continuous positive airway pressure (CPAP) is a remedy that involves using air pressure to keep the airways open. It is often used in the treatment of sleep apnea.

The proper code for this type of treatment is 5A09357, which stands for assistance with respiratory ventilation for less than 24 consecutive hours using continuous positive airway pressure. The “5” puts it in the section of extracorporeal assistance and performance, which is a procedure that happens outside of the body.

The “A” denotes that a physiological system is being affected by the procedure. The “0” indicates that the root operation is assistance. The “9” indicates that there is no specific body part being affected. The “3” shows that it is an external approach. The “5” denotes that it is using a ventilation device. The “7” indicates that continuous positive airway pressure is being used.

Conclusions

Billing codes for Sleep Medicine are similar to those used for other aspects of the medical field. Even though the codes for diagnosis often change, it is important to follow the patterns set forth in the ICD-10 in order to correctly code both the diagnosis and the procedures used in sleep medicine.

MPMR has expert certified coders who are well versed in ICD-10 and can help your practice tremendously with the upcoming changes. For sleep medicine, even subtle coding issues can result in tens of thousands of dollars in lost revenue.

Call MPMR today to find out how your sleep center can benefit from their service!

Resources

http://www.icd10data.com/ICD10PCS/Codes/5

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_044956.hcsp?dDocName=bok1_044956