How To Use CPT Code 95808

CPT 95808 describes the procedure for polysomnography, a sleep study that measures biophysiological changes that occur while a patient is sleeping. 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 95808?

CPT 95808 can be used to describe the procedure for polysomnography, a sleep study that measures various biophysiological changes that occur while a patient is sleeping. This test helps physicians diagnose sleep disorders and is typically performed by a technologist in a clinic or sleep lab. During the test, the technologist attaches wires to the patient to measure functions such as brain activity, eye movements, muscle activity, heart rate, respiratory effort and airflow, and oxygen levels. The technologist continuously monitors the patient using recording equipment, which produces auditory and video recordings. The results of the test are then interpreted by a physician.

2. Official Description

The official description of CPT code 95808 is: ‘Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist.’

3. Procedure

1. The technologist attaches wires to the patient to measure various biophysiological functions during sleep.
2. The technologist uses a polysomnogram to measure brain activity, eye movements, muscle activity, heart rate, respiratory effort and airflow, and oxygen levels.
3. The technologist continuously monitors the patient during the sleep study using recording equipment.
4. The recording equipment produces auditory and video recordings of the patient’s sleep.
5. The results of the sleep study are then interpreted by a physician.

4. Qualifying circumstances

Polysomnography is typically performed on patients who are suspected of having sleep disorders. The test is attended by a technologist and involves the measurement of various biophysiological functions during sleep. The additional parameters of sleep that may be measured during the test include electromyography (EMG) of the anterior tibialis muscle, respiratory monitoring, electrocardiogram (ECG), pulse oximetry, airflow measurement, esophageal pH monitoring, esophageal pressure monitoring, blood pressure monitoring, extended EEG monitoring, penile tumescence, the patient’s position of sleep, and snoring.

5. When to use CPT code 95808

CPT code 95808 should be used when performing polysomnography, a sleep study that measures various biophysiological changes during sleep. It is appropriate to bill this code when a technologist attends the sleep study and records the necessary parameters. This code should be used for patients of any age.

6. Documentation requirements

To support a claim for CPT code 95808, the following documentation is required:

• Record of the patient’s sleep study, including the start and end time of the study
• Details of the biophysiological functions measured during the study
• Results of the sleep study, including any abnormalities or sleep disorders diagnosed
• Interpretation of the sleep study by a physician

7. Billing guidelines

When billing for CPT code 95808, ensure that the sleep study is attended by a technologist and that the necessary parameters are recorded. If only the physician’s interpretation is being reported, append modifier 26 to the code. If only the technical component is being reported, append modifier TC to the code. Do not append a professional or technical modifier if reporting a global service in which one provider renders both components. It is important to follow Medicare and private insurer guidelines for reporting polysomnography codes, including the requirement for measuring parameters for six hours or more with physician review, interpretation, and report. Modifier -52 should be appended if the sleep study lasts less than six hours.

8. Historical information

CPT code 95808 was added to the Current Procedural Terminology system on January 1, 1994. The code underwent a change on January 1, 2013, with the description being updated to include the measurement of 1-3 additional parameters of sleep.

9. Examples

1. A technologist performs a polysomnography on a 45-year-old patient to measure their brain activity, eye movements, muscle activity, heart rate, respiratory effort and airflow, and oxygen levels during sleep.
2. A sleep study is conducted on a 10-year-old child to diagnose a suspected sleep disorder. The technologist attaches wires to the child to measure various biophysiological functions during sleep, and the results are later interpreted by a physician.
3. A patient undergoes polysomnography to monitor their sleep patterns and diagnose any potential sleep disorders. The technologist records the patient’s brain activity, eye movements, muscle activity, heart rate, respiratory effort and airflow, and oxygen levels during the sleep study.
4. A technologist attends a sleep study for a 60-year-old patient who is experiencing symptoms of sleep apnea. The technologist measures the patient’s biophysiological functions during sleep and records the necessary parameters for further interpretation by a physician.
5. A sleep study is performed on a 30-year-old patient to evaluate their sleep patterns and diagnose any potential sleep disorders. The technologist attaches wires to the patient to measure brain activity, eye movements, muscle activity, heart rate, respiratory effort and airflow, and oxygen levels during the study.