How To Use CPT Code 95800

CPT 95800 is a code for unattended sleep studies that record heart rate, oxygen saturation, respiratory analysis, and sleep time. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 95800.

1. What is CPT 95800?

CPT 95800 is a medical billing code used for unattended sleep studies that simultaneously record various parameters, including heart rate, oxygen saturation, respiratory analysis, and sleep time. This code is used by medical coders and billers to report and bill for these specific diagnostic services provided to patients with suspected sleep disorders.

2. 95800 CPT code description

The official description of CPT code 95800 is: “Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time.”

3. Procedure

The 95800 CPT code procedure involves the following steps:

1. Patient preparation: The patient is prepared for the sleep study by attaching sensors to their body to monitor heart rate, oxygen saturation, and respiratory analysis.
2. Unattended sleep study: The patient undergoes the sleep study without a provider physically present. The study records the patient’s heart rate, oxygen saturation, respiratory analysis, and sleep time.
3. Data analysis: The recorded data is analyzed by a healthcare professional to diagnose potential sleep disorders and determine appropriate treatment options.

4. Qualifying circumstances

Patients eligible to receive CPT code 95800 services are those who:

• Have symptoms or risk factors for sleep disorders, such as excessive daytime sleepiness, snoring, or sleep apnea.
• Require a diagnostic sleep study to determine the presence and severity of a sleep disorder.
• Can safely undergo an unattended sleep study without the need for continuous monitoring by a healthcare professional.

5. When to use CPT code 95800

It is appropriate to bill the 95800 CPT code when a patient undergoes an unattended sleep study that simultaneously records heart rate, oxygen saturation, respiratory analysis, and sleep time for the purpose of diagnosing sleep disorders. The sleep study must be conducted without a provider physically present, and the recorded data must be analyzed by a healthcare professional to determine the presence and severity of any sleep disorders.

6. Documentation requirements

To support a claim for CPT 95800, the following information must be documented:

• Patient’s medical history, including symptoms and risk factors for sleep disorders.
• Reason for the sleep study and its necessity in diagnosing the patient’s sleep disorder.
• Details of the unattended sleep study, including the parameters recorded and the duration of the study.
• Results of the data analysis, including any diagnosed sleep disorders and recommended treatment options.

7. Billing guidelines

When billing for CPT code 95800, keep in mind the following guidelines:

• The code requires at least six hours of recording. If the study is less than six hours, append reduced services modifier 52.
• If documentation does not include sleep time, use CPT 95801 instead.
• For reporting only the professional component, append professional component modifier 26 to the code.
• For reporting only the technical component, append technical component modifier TC to the code, unless the hospital provided the technical component. In that case, do not append modifier TC.
• Do not append a professional or technical modifier when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 95800 was added to the Current Procedural Terminology system on January 1, 2011. There have been no updates to the code since its addition.

9. Similar codes to CPT 95800

Five similar codes to CPT 95800 and how they differentiate are:

• CPT 95801: An unattended sleep study that measures a minimum of heart rate, oxygen saturation, and respiratory analysis, but does not include sleep time.
• CPT 95803: An actigraphy recording for the assessment of sleep disorders, which measures movement rather than heart rate, oxygen saturation, and respiratory analysis.
• CPT 95805: A multiple sleep latency test or maintenance of wakefulness test, which assesses daytime sleepiness and the ability to stay awake.
• CPT 95806: An attended sleep study that records the same parameters as CPT 95800 but with a provider physically present during the study.
• CPT 95807: A sleep study that records additional parameters, such as electroencephalography (EEG), electromyography (EMG), and electrooculography (EOG).

10. Examples

Here are 10 detailed examples of CPT code 95800 procedures:

1. A 45-year-old patient with excessive daytime sleepiness and loud snoring undergoes an unattended sleep study to assess for sleep apnea.
2. A 60-year-old patient with a history of hypertension and obesity undergoes an unattended sleep study to evaluate the presence of sleep-disordered breathing.
3. A 35-year-old patient with restless leg syndrome undergoes an unattended sleep study to determine the impact of the condition on their sleep quality.
4. A 50-year-old patient with a family history of sleep apnea undergoes an unattended sleep study to assess their risk of developing the disorder.
5. A 40-year-old patient with insomnia undergoes an unattended sleep study to evaluate the cause of their sleep disturbances.
6. A 55-year-old patient with a history of stroke undergoes an unattended sleep study to assess the presence of sleep-disordered breathing as a potential risk factor for future strokes.
7. A 30-year-old patient with narcolepsy undergoes an unattended sleep study to evaluate the severity of their sleep disorder and determine appropriate treatment options.
8. A 65-year-old patient with chronic fatigue syndrome undergoes an unattended sleep study to assess the quality of their sleep and identify any underlying sleep disorders.
9. A 70-year-old patient with a history of heart failure undergoes an unattended sleep study to evaluate the presence of sleep-disordered breathing as a potential contributing factor to their condition.
10. A 20-year-old patient with suspected sleepwalking undergoes an unattended sleep study to determine the cause of their nocturnal episodes and identify appropriate treatment options.