How To Use CPT Code 95805

CPT 95805 describes the procedure for multiple sleep latency or maintenance of wakefulness testing, which involves recording, analyzing, and interpreting physiological measurements of sleep during multiple trials to assess sleepiness. 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 95805?

CPT 95805 can be used to describe the procedure for multiple sleep latency or maintenance of wakefulness testing. This code involves the recording, analysis, and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness. It is typically performed in a sleep lab setting.

2. Official Description

The official description of CPT code 95805 is: ‘Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness.’

3. Procedure

1. During multiple sleep latency testing, the patient undergoes a series of trials throughout the day, typically five times, with each trial lasting for two hours.
2. A polysomnogram is usually conducted the night before the testing to gather baseline data on the patient’s sleep patterns.
3. A technician attaches electrodes to the patient’s head to monitor brain activity and other physiological parameters, such as oxygen levels and heart rate.
4. The patient is instructed to try to fall asleep during each trial, and the technician records the time it takes for the patient to fall asleep.
5. The technician also monitors the specific sleep stages the patient enters and the duration of each stage.
6. Maintenance of wakefulness testing assesses the patient’s ability to stay awake throughout the day.
7. Similar to multiple sleep latency testing, the patient undergoes four phases of testing, which are two hours apart.
8. The technician attaches electrodes to monitor brain activity, heart rate, eye movements, and muscle contractions.
9. The patient is instructed to stay awake during each phase, and the technician records any lapses into sleep.

4. Qualifying circumstances

CPT 95805 is typically performed to assist physicians in diagnosing various sleep disorders. It is used to assess a patient’s sleepiness level and their ability to stay awake. The procedure requires the expertise of a qualified healthcare professional, such as a sleep technologist or technician, who is trained in conducting and interpreting sleep studies. The patient must meet specific criteria for undergoing the testing, which may vary depending on the physician’s assessment and the patient’s symptoms.

5. When to use CPT code 95805

CPT code 95805 should be used when a healthcare professional performs multiple sleep latency or maintenance of wakefulness testing to assess a patient’s sleepiness level and ability to stay awake. This code is appropriate for recording, analyzing, and interpreting physiological measurements of sleep during multiple trials. It is typically used in a sleep lab setting and requires the expertise of a qualified healthcare professional.

6. Documentation requirements

To support a claim for CPT 95805, the healthcare professional must document the following information:

• Reason for performing the testing and the patient’s symptoms or suspected sleep disorder
• Date and duration of each trial
• Results of the physiological measurements, including sleep latency, sleep stages, and any lapses into sleep during maintenance of wakefulness testing
• Interpretation of the test results and any additional recommendations or follow-up required
• Signature of the qualified healthcare professional conducting and interpreting the testing

7. Billing guidelines

When billing for CPT 95805, ensure that the procedure is performed by a qualified healthcare professional with expertise in sleep studies. Follow the specific guidelines provided by the payer regarding documentation and coding requirements. It is important to accurately report the duration and number of trials conducted during the testing. Additionally, be aware of any bundling or unbundling rules that may apply to CPT 95805 and other related codes.

8. Historical information

CPT 95805 was added to the Current Procedural Terminology system on January 1, 1991. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes multiple sleep latency testing to assess their sleepiness level and determine if they have narcolepsy.
2. A patient with suspected sleep apnea undergoes maintenance of wakefulness testing to evaluate their ability to stay awake throughout the day.
3. A physician orders multiple sleep latency testing for a patient experiencing excessive daytime sleepiness to assess the severity of their condition.
4. A patient with restless leg syndrome undergoes maintenance of wakefulness testing to determine if their symptoms are affecting their ability to stay awake during the day.
5. A sleep technologist performs multiple sleep latency testing on a patient with suspected idiopathic hypersomnia to assess their sleepiness level and help with the diagnosis.
6. A patient with suspected circadian rhythm disorder undergoes maintenance of wakefulness testing to evaluate their ability to stay awake during their desired wakeful periods.