How To Use CPT Code 95801

CPT 95801 describes the unattended sleep study procedure that measures the minimum of heart rate, oxygen saturation, and respiratory analysis. 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 95801?

CPT 95801 can be used to describe the unattended sleep study procedure that evaluates physiological functioning while the patient is asleep. This code specifically measures the minimum of heart rate, oxygen saturation, and respiratory analysis using laboratory or portable technology. It is important to note that CPT 95801 should not be reported in conjunction with certain other codes, such as 93041-93227, 93228, 93229, 93268-93272, and 95800.

2. Official Description

The official description of CPT code 95801 is: ‘Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone).’ It is important to remember not to report 95801 with the aforementioned codes.

3. Procedure

1. During the unattended sleep study, the patient wears comfortable clothing and is connected to equipment that measures physiological functions.
2. The equipment includes sticky pads on the patient’s chest to monitor heart rate, a cloth belt across the chest and stomach to monitor respiratory rate, and a device on the patient’s finger to measure peripheral arterial tone and oxygen saturation.
3. A sleep technician is not present during the study, and the patient sleeps in their own environment.
4. After the study, the recorded data is collected and analyzed by a physician who specializes in sleep medicine.

4. Qualifying circumstances

CPT 95801 is used for patients who require an unattended sleep study to diagnose sleep disorders, such as sleep apnea, sleepwalking, or insomnia. The study evaluates physiological functioning while the patient is asleep and specifically measures heart rate, oxygen saturation, and respiratory analysis. It is important to note that CPT 95801 should not be reported with certain other codes, as mentioned earlier.

5. When to use CPT code 95801

CPT code 95801 should be used when a patient requires an unattended sleep study that measures the minimum of heart rate, oxygen saturation, and respiratory analysis. It is important to ensure that the study is unattended and that the specific parameters are being measured. If additional parameters or sleep time are also being measured, CPT code 95800 should be used instead.

6. Documentation requirements

To support a claim for CPT 95801, the following documentation is required:

• Indication of the need for an unattended sleep study
• Record of the specific parameters measured (heart rate, oxygen saturation, respiratory analysis)
• Date and duration of the study
• Results and interpretation of the study by a sleep medicine specialist

7. Billing guidelines

When billing for CPT 95801, ensure that the study meets the criteria for an unattended sleep study and that the specific parameters (heart rate, oxygen saturation, respiratory analysis) are being measured. It is important to follow the guidelines and not report CPT 95801 with certain other codes. Modifier 26 should be appended if reporting only the physician’s interpretation, and modifier TC should be appended if reporting only the technical component. However, if the hospital provided the technical component, modifier TC should not be appended. It is crucial to accurately report the professional and technical components based on the specific circumstances.

8. Historical information

CPT 95801 was added to the Current Procedural Terminology system on January 1, 2011. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes an unattended sleep study to measure heart rate, oxygen saturation, and respiratory analysis to diagnose sleep apnea.
2. An individual with insomnia undergoes an unattended sleep study to evaluate heart rate, oxygen saturation, and respiratory analysis during sleep.
3. A patient with suspected sleepwalking undergoes an unattended sleep study to monitor heart rate, oxygen saturation, and respiratory analysis during sleep.
4. An individual with excessive daytime sleepiness undergoes an unattended sleep study to measure heart rate, oxygen saturation, and respiratory analysis to determine the cause of their symptoms.
5. A patient with suspected sleep-related movement disorder undergoes an unattended sleep study to evaluate heart rate, oxygen saturation, and respiratory analysis during sleep.
6. An individual with restless legs syndrome undergoes an unattended sleep study to monitor heart rate, oxygen saturation, and respiratory analysis during sleep.
7. A patient with suspected periodic limb movement disorder undergoes an unattended sleep study to measure heart rate, oxygen saturation, and respiratory analysis during sleep.
8. An individual with suspected nocturnal seizures undergoes an unattended sleep study to evaluate heart rate, oxygen saturation, and respiratory analysis during sleep.
9. A patient with suspected narcolepsy undergoes an unattended sleep study to monitor heart rate, oxygen saturation, and respiratory analysis to aid in the diagnosis.
10. An individual with suspected circadian rhythm sleep disorder undergoes an unattended sleep study to measure heart rate, oxygen saturation, and respiratory analysis during sleep.