How To Use HCPCS Code G0398

HCPCS code G0398 describes a home sleep study test (hst) with a type II portable monitor, which is conducted in an unattended setting. This test requires a minimum of seven channels to monitor various physiological parameters, including EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort, and oxygen saturation. It is categorized under the type of service code 5, which represents diagnostic laboratory services.

1. What is HCPCS G0398?

HCPCS code G0398 is used to identify a specific type of diagnostic test known as a home sleep study test. This test is conducted using a type II portable monitor and is performed in an unattended setting. The purpose of this test is to monitor and evaluate various physiological parameters during sleep, such as brain activity, eye movements, muscle activity, heart rate, airflow, respiratory effort, and oxygen saturation.

2. Official Description

The official description of HCPCS code G0398 is “Home sleep study test (hst) with type II portable monitor, unattended; minimum of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort, and oxygen saturation.” The short description for this code is “Home sleep test/type 2 porta.”

3. Procedure

1. The provider attaches the necessary monitoring devices to the patient before they go to sleep.
2. The patient performs their regular sleep routine at home while wearing the monitoring devices.
3. The monitoring devices record the various physiological parameters throughout the sleep duration.
4. Once the sleep study is completed, the patient returns the monitoring devices to the provider.
5. The recorded data is then analyzed and interpreted by a qualified healthcare professional.
6. A comprehensive report is generated, detailing the findings and any potential sleep disorders or abnormalities.

4. When to use HCPCS code G0398

HCPCS code G0398 should be used when a healthcare provider orders a home sleep study test using a type II portable monitor. This code is appropriate for patients who require evaluation of their sleep patterns and physiological parameters in an unattended setting. It is important to note that this code is not applicable for in-lab sleep studies or other types of sleep tests.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0398, healthcare providers need to ensure that the following documentation requirements are met:

• A detailed order from the provider for the home sleep study test.
• Documentation of the patient’s symptoms or medical condition necessitating the sleep study.
• Documentation of the specific physiological parameters monitored during the test.
• A comprehensive report of the sleep study findings, including any diagnoses or recommendations.

6. Historical Information and Code Maintenance

HCPCS code G0398 was added to the Healthcare Common Procedure Coding System on March 13, 2008. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G0398 is eligible for coverage by Medicare and other insurance providers. The pricing indicator code for this code is 13, which indicates that the price is established by carriers based on individual determination and carrier discretion. The multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of scenarios where HCPCS code G0398 should be billed:

1. A patient with suspected sleep apnea undergoes a home sleep study test using a type II portable monitor to evaluate their sleep patterns and physiological parameters.
2. A healthcare provider orders a home sleep study test for a patient who experiences excessive daytime sleepiness and wants to assess their sleep quality.
3. A patient with a history of insomnia undergoes a home sleep study test to monitor their sleep patterns and identify any underlying causes of their sleep disturbances.
4. A healthcare provider orders a home sleep study test for a patient with suspected periodic limb movement disorder to evaluate their muscle activity and sleep disruptions.
5. A patient with a known sleep disorder undergoes a follow-up home sleep study test to assess the effectiveness of their current treatment plan.