How To Use CPT Code 95810

CPT 95810 refers to polysomnography for patients aged six years or older, involving sleep staging with four or more additional parameters of sleep, attended by a technologist. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 95810.

1. What is CPT 95810?

CPT 95810 is a medical code used to describe a specific type of polysomnography, which is a diagnostic test that monitors and records various physiological and pathophysiological parameters of sleep. This code is specifically for patients aged six years or older and involves sleep staging with four or more additional parameters of sleep, attended by a technologist. The test is performed to diagnose a variety of sleep disorders and evaluate a patient’s response to therapies such as continuous positive airway pressure (CPAP).

2. 95810 CPT code description

The official description of CPT code 95810 is: “Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist.”

3. Procedure

The 95810 procedure involves the following steps:

1. The patient arrives at the sleep center during their regular sleep period, typically at night.
2. A technologist attaches electrodes and sensors to the patient’s head, face, chest, and limbs to monitor various physiological parameters.
3. The patient goes to sleep, and the technologist monitors the patient’s sleep patterns, brain activity (EEG), heart activity (ECG), muscle activity (EMG), eye movements (EOG), respiration, and pulse oximetry for at least six hours.
4. The technologist remains in attendance throughout the study to ensure proper data collection and patient safety.
5. After the study, the data is reviewed, interpreted, and reported by a physician.

4. Qualifying circumstances

Patients eligible to receive CPT code 95810 services are those aged six years or older who present with symptoms or clinical indications suggestive of a sleep disorder. These may include excessive daytime sleepiness, snoring, witnessed apneas, unrefreshing sleep, insomnia, or abnormal behaviors during sleep. A physician must determine the medical necessity for the polysomnography based on the patient’s history, physical examination, and any relevant diagnostic tests.

5. When to use CPT code 95810

It is appropriate to bill the 95810 CPT code when a patient aged six years or older requires a polysomnography to diagnose or evaluate a sleep disorder, and the study includes sleep staging with four or more additional parameters of sleep, attended by a technologist. The test should be medically necessary, as determined by a physician, and performed in accordance with established clinical guidelines and protocols.

6. Documentation requirements

To support a claim for CPT 95810, the following information should be documented:

• Patient’s age, symptoms, and clinical indications for the polysomnography.
• Physician’s determination of medical necessity for the test.
• Details of the sleep study, including the parameters monitored, duration, and technologist’s attendance.
• Physician’s review, interpretation, and report of the polysomnography results.
• Diagnosis or evaluation of the patient’s sleep disorder based on the test results.

7. Billing guidelines

When billing for CPT code 95810, it is essential to ensure that the procedure is medically necessary and performed according to established clinical guidelines. Additionally, proper documentation should be maintained to support the claim. It is also important to be aware of any payer-specific rules or requirements related to billing for polysomnography services. In some cases, preauthorization may be required before the test can be performed.

8. Historical information

CPT 95810 was added to the Current Procedural Terminology system on January 1, 1994. The code was changed on January 1, 2013, with the previous descriptor being “Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist.”

9. Similar codes to CPT 95810

Five similar codes to CPT 95810 and how they differ are:

• CPT 95782: This code is for polysomnography in patients younger than six years old, with the same parameters and technologist attendance as CPT 95810.
• CPT 95811: This code is similar to CPT 95810 but includes continuous positive airway pressure (CPAP) therapy or bilevel positive airway pressure (BiPAP) therapy during the study.
• CPT 95805: This code is for multiple sleep latency testing or maintenance of wakefulness testing, which are different types of sleep studies that assess daytime sleepiness and alertness.
• CPT 95806: This code is for a sleep study that includes heart rate, oxygen saturation, and respiratory analysis but does not include sleep staging or technologist attendance.
• CPT 95807: This code is for a sleep study that includes sleep staging, heart rate, oxygen saturation, and respiratory analysis but does not require technologist attendance.

10. Examples

Here are 10 detailed examples of CPT code 95810 procedures:

1. A 10-year-old child with excessive daytime sleepiness and snoring undergoes a polysomnography to evaluate for sleep apnea.
2. A 35-year-old patient with a history of insomnia and unrefreshing sleep undergoes a polysomnography to assess for sleep-related breathing disorders.
3. A 50-year-old patient with witnessed apneas and morning headaches undergoes a polysomnography to diagnose obstructive sleep apnea.
4. A 20-year-old patient with a history of narcolepsy undergoes a polysomnography to evaluate the effectiveness of their current treatment.
5. A 60-year-old patient with restless leg syndrome and periodic limb movements during sleep undergoes a polysomnography to assess the severity of their condition.
6. A 45-year-old patient with a history of sleepwalking undergoes a polysomnography to evaluate for any underlying sleep disorders.
7. A 30-year-old patient with chronic fatigue syndrome undergoes a polysomnography to assess for sleep-related breathing disorders or other sleep abnormalities.
8. A 25-year-old patient with a history of night terrors undergoes a polysomnography to evaluate for any underlying sleep disorders.
9. A 55-year-old patient with a history of hypertension and obesity undergoes a polysomnography to assess for sleep apnea as a contributing factor to their medical condition.
10. A 40-year-old patient with a history of depression and sleep disturbances undergoes a polysomnography to evaluate for any underlying sleep disorders that may be contributing to their mental health condition.