How To Use CPT Code 95783

CPT 95783 describes the polysomnography procedure for patients under the age of 6, which includes sleep staging and the initiation of continuous positive airway pressure therapy or bi-level ventilation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95783?

CPT 95783 is used to describe the attended sleep study procedure for patients under the age of 6. This procedure involves the identification of sleep levels and at least four additional sleep parameters. It also includes the initiation of continuous positive airway pressure therapy or bi-level ventilation. The purpose of this code is to assess and diagnose various sleep disorders in young patients.

2. Official Description

The official description of CPT code 95783 is: ‘Polysomnography; younger than 6 years, 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.’

3. Procedure

  1. During the polysomnography procedure, a qualified healthcare professional, such as a technologist, is present with the patient to record the sleep study.
  2. The procedure involves the use of various monitoring devices to assess the patient’s sleep levels, including electroencephalography (EEG), electromyography (EMG), and electrooculography (EOG).
  3. In addition to sleep staging, at least four additional sleep parameters are recorded, such as electrocardiogram (ECG), airflow, respiratory effort, oxyhemoglobin saturation, capnography, or bilateral anterior tibialis EMG.
  4. The healthcare professional also initiates continuous positive airway pressure therapy or bi-level ventilation during the study, fitting the patient with a mask and adjusting the positive airway pressure to address any breathing issues.

4. Qualifying circumstances

CPT 95783 is used for patients under the age of 6 who require a polysomnography procedure to assess and diagnose sleep disorders. The procedure must include sleep staging with at least four additional parameters of sleep. The patient must also receive continuous positive airway pressure therapy or bi-level ventilation during the study. The procedure must be attended by a qualified healthcare professional, such as a technologist.

5. When to use CPT code 95783

CPT code 95783 should be used when performing a polysomnography procedure for patients under the age of 6. This code is appropriate when sleep staging is conducted, at least four additional sleep parameters are recorded, and continuous positive airway pressure therapy or bi-level ventilation is initiated during the study. It is important to ensure that the procedure is attended by a qualified healthcare professional.

6. Documentation requirements

To support a claim for CPT 95783, the healthcare professional must document the following information:

  • Patient’s age and the need for a polysomnography procedure
  • Specific sleep parameters recorded during the study
  • Date and duration of the procedure
  • Initiation of continuous positive airway pressure therapy or bi-level ventilation
  • Signature of the attending healthcare professional

7. Billing guidelines

When billing for CPT 95783, ensure that the procedure meets the qualifying circumstances, including the age of the patient, sleep staging, additional sleep parameters, and initiation of continuous positive airway pressure therapy or bi-level ventilation. It is important to append the appropriate modifiers if reporting only the professional or technical component of the service. If reporting a global service, where one provider renders both components, modifiers are not necessary.

8. Historical information

CPT 95783 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Examples

  1. A technologist conducts a polysomnography procedure for a 4-year-old patient, recording sleep staging, electrocardiogram, airflow, respiratory effort, and initiating continuous positive airway pressure therapy.
  2. A sleep specialist performs a polysomnography procedure for a 5-year-old patient, recording sleep staging, electroencephalography, electromyography, electrooculography, and initiating bi-level ventilation.
  3. A technologist conducts a polysomnography procedure for a 3-year-old patient, recording sleep staging, oxyhemoglobin saturation, capnography, bilateral anterior tibialis EMG, and initiating continuous positive airway pressure therapy.
  4. A sleep specialist performs a polysomnography procedure for a 2-year-old patient, recording sleep staging, electrocardiogram, airflow, respiratory effort, and initiating bi-level ventilation.
  5. A technologist conducts a polysomnography procedure for a 6-year-old patient, recording sleep staging, electroencephalography, electromyography, electrooculography, and initiating continuous positive airway pressure therapy.
  6. A sleep specialist performs a polysomnography procedure for a 4-year-old patient, recording sleep staging, oxyhemoglobin saturation, capnography, bilateral anterior tibialis EMG, and initiating bi-level ventilation.
  7. A technologist conducts a polysomnography procedure for a 5-year-old patient, recording sleep staging, electrocardiogram, airflow, respiratory effort, and initiating continuous positive airway pressure therapy.
  8. A sleep specialist performs a polysomnography procedure for a 3-year-old patient, recording sleep staging, electroencephalography, electromyography, electrooculography, and initiating bi-level ventilation.

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