Billing for incomplete Home sleep studies

mpritchard@nmhs.netmpritchard@nmhs.net
in BILLING AND CLAIMS
How does everyone bill (if you bill) for incomplete or failed home sleep studies. We frequently have patients who end up with failed studies on more than one occasion.

Comments

  • dwilliamsrsidwilliamsrsi
    Modifier 52 would be applicable if less than 6 hours of recording was accomplished.  All of the MAC LCDs or coding articles support that the 6 hours applies to home studies.  According to our coding software, modifier 52 is appropriate with the G codes.  The question is whether all unsuccessful attempts at a home sleep study are considered covered.  I didn't find a limitation on the number, but I would assume payers would have a limitation.  For non-Medicare payers, I would check their coverage guidelines.   
  • trositrosi

    We use -52 for most of our <6 hr studies as well.  We sometimes have patients who get prepped and start the study, but for whatever reason decide not to finish in a shorter period of time.  In these cases, if it was no fault of the facility, we use an E/M charge for this work/time of staff when a "study" wasn't really started. 

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