How To Use CPT Code 95811

CPT 95811 refers to polysomnography for patients aged six years or older, with sleep staging, four or more additional parameters of sleep, and initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 95811 procedures.

1. What is CPT 95811?

CPT 95811 is a medical procedure code used to describe polysomnography, a diagnostic test that monitors and records various physiological parameters during sleep. This code specifically applies to patients aged six years or older and includes sleep staging, four or more additional parameters of sleep, and initiation of continuous positive airway pressure (CPAP) therapy or bilevel ventilation. The procedure is attended by a technologist to ensure patient safety and comfort.

2. 95811 CPT code description

The official description of CPT code 95811 is: “Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist.”

3. Procedure

The 95811 procedure involves the following steps:

  1. Patient preparation: The patient is prepared for the study, which typically takes place during their regular sleep period at night.
  2. Electrode placement: Electrodes are placed on the patient’s scalp, face, chest, and limbs to monitor various physiological parameters.
  3. Monitoring: The technologist monitors the patient’s sleep pattern, brain activity (EEG), heart activity (ECG), muscle activity (EMG), eye movement (EOG), respiration, and pulse oximetry throughout the night.
  4. Initiation of therapy: Continuous positive airway pressure (CPAP) therapy or bilevel ventilation is initiated during the study, as needed.
  5. Data analysis: The recorded data is analyzed by a physician to diagnose sleep disorders and determine appropriate treatment options.

4. Qualifying circumstances

Patients eligible to receive CPT code 95811 services are those who exhibit symptoms or have a history of sleep disorders, such as excessive daytime sleepiness, snoring, witnessed apneic episodes, or abnormal leg movements during sleep. The procedure may also be used to evaluate a patient’s response to CPAP therapy or other treatments for sleep disorders. The study must be attended by a trained technologist and supervised by a physician experienced in analyzing and interpreting polysomnography recordings.

5. When to use CPT code 95811

CPT code 95811 should be used when a patient aged six years or older requires polysomnography to diagnose or evaluate sleep disorders, and the study includes sleep staging, four or more additional parameters of sleep, and initiation of CPAP therapy or bilevel ventilation. The procedure must be attended by a technologist to ensure patient safety and comfort.

6. Documentation requirements

To support a claim for CPT 95811, the following information must be documented:

  • Patient’s age and relevant medical history
  • Indications for the study, such as symptoms or history of sleep disorders
  • Details of the procedure, including sleep staging, additional parameters monitored, and therapy initiation
  • Technologist’s attendance and supervision by a qualified physician
  • Results of the study, including any diagnosed sleep disorders and recommended treatments

7. Billing guidelines

When billing for CPT code 95811, it is essential to follow the appropriate guidelines and rules. Ensure that the patient meets the qualifying circumstances for the procedure, and that the study is attended by a technologist and supervised by a qualified physician. Additionally, maintain thorough documentation to support the claim, including patient information, procedure details, and study results.

8. Historical information

CPT 95811 was added to the Current Procedural Terminology system on January 1, 1998. The code was changed on January 1, 2013, with the previous descriptor being “Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist.”

9. Similar codes to CPT 95811

Five similar codes to CPT 95811 include:

  • CPT 95810: Polysomnography without CPAP or bilevel ventilation, attended by a technologist
  • CPT 95805: Multiple sleep latency testing, measuring daytime sleepiness
  • CPT 95806: Sleep study, unattended, simultaneous recording of multiple parameters
  • CPT 95807: Sleep study, attended, with fewer than four additional parameters of sleep
  • CPT 95808: Polysomnography with CPAP or bilevel ventilation, but for patients younger than six years old

10. Examples

Here are 10 detailed examples of CPT code 95811 procedures:

  1. A 35-year-old patient with excessive daytime sleepiness undergoes polysomnography, including sleep staging, EEG, ECG, EMG, EOG, respiration, pulse oximetry, and initiation of CPAP therapy, attended by a technologist.
  2. An 18-year-old patient with a history of snoring and witnessed apneic episodes undergoes polysomnography with sleep staging, four additional parameters, and bilevel ventilation initiation, attended by a technologist.
  3. A 45-year-old patient with restless leg syndrome undergoes polysomnography, including sleep staging, EEG, ECG, EMG, EOG, respiration, pulse oximetry, and initiation of CPAP therapy, attended by a technologist.
  4. A 60-year-old patient with suspected sleep apnea undergoes polysomnography with sleep staging, four additional parameters, and bilevel ventilation initiation, attended by a technologist.
  5. A 50-year-old patient with narcolepsy undergoes polysomnography, including sleep staging, EEG, ECG, EMG, EOG, respiration, pulse oximetry, and initiation of CPAP therapy, attended by a technologist.
  6. A 40-year-old patient with a history of periodic limb movements during sleep undergoes polysomnography with sleep staging, four additional parameters, and bilevel ventilation initiation, attended by a technologist.
  7. A 55-year-old patient with insomnia undergoes polysomnography, including sleep staging, EEG, ECG, EMG, EOG, respiration, pulse oximetry, and initiation of CPAP therapy, attended by a technologist.
  8. An 8-year-old patient with suspected sleep-disordered breathing undergoes polysomnography with sleep staging, four additional parameters, and bilevel ventilation initiation, attended by a technologist.
  9. A 65-year-old patient with a history of parasomnia undergoes polysomnography, including sleep staging, EEG, ECG, EMG, EOG, respiration, pulse oximetry, and initiation of CPAP therapy, attended by a technologist.
  10. A 70-year-old patient with suspected central sleep apnea undergoes polysomnography with sleep staging, four additional parameters, and bilevel ventilation initiation, attended by a technologist.

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