Have you ever realized that almost 50 million Americans regularly struggle with their sleeping time? No wonder, it’s a huge number!  To figure out why they can’t sleep, doctors thoroughly study their sleeping system. These studies help track things like how their patients sleep, if they stop breathing while sleeping, and how their brains work while they rest. It's pretty comprehensive, but these tests are super important to understand why some people can’t get a good night’s sleep. 

As a sleep study specialist, you need to figure out how it would take to conduct a sleep test and analyze the results for your patients. The sleep study billing services and coding completely depend on whether you are performing the sleep test in your patient’s home or your sleep clinic. It’s like two different ways to track how you sleep, and each one has its own way of handling the costs. 

Depending on what a physician says, sleep studies can be either attended (where someone helps you during the test) or unattended (where you do it on your own). You might also need different tools for monitoring. Plus, where you do the test and what type of sleep test it is will affect which billing code is used. Your patient’s insurance coverage also plays a part in all of this! 

As you already have started realizing the truth that managing sleep study billing services is not a cup of tea for everyone as it involves so many procedures, factors, codes, modifiers and other billing parameters. However, you still can manage your sleep study billing well if you know have a clear idea about the common codes used in sleep study billing services.  

Commonly used CPT, HCPCS and ICD-10 codes:  

CPT Codes based on the procedures that you have performed:  

- 95800: This is for a sleep study you do on your own (unattended) where they check your patient’s oxygen levels, heart rate, breathing, and sleep time all at once. 

- 95801: You need to assign this code when you check a patient’s heart rate, oxygen, and breathing. 

- 95806: Assign this code when you check your patient’s heart rate, oxygen levels, breathing, and how hard you’re breathing. 

- 95807: This is for a sleep study with a technician helping you (attended). You need to use this code when you check your patient’s heart, breathing and how they are breathing, how well their lugs is working and oxygen level. 

Frequent CPT codes that you use based on the parameters:  

- 95808: This is for a sleep study at any age with 1-3 sleep details checked, and a technician helps you. 

- 95810: This is for a sleep study for kids 6 and up, with 4 or more sleep details checked, and a technician helps you. 

- 95811: This is for a sleep study for kids 6 and up, with 4 or more sleep details checked, and they start CPAP or bi-level therapy, with a technician helping. 

- 95782: This is for a sleep study for kids under 6, with 4 or more sleep details checked, and a technician helps you. 

HCPCS codes that you should learn about:  

- G0398: This is for an at-home sleep test with 7 channels (like heart rate, brain activity, and oxygen levels) and no technician. 

- G0399: You need to assign this code when you perform sleep test with 4 channels like heart rate, breathing, and oxygen levels and no technician. 

- G0400: You should assign this HCPCS code when you conduct a sleep test with 3 channels and no technician. 

Frequently used ICD-10 codes in your sleep study billing services:  

- G47.33: You must use this code to define obstructive sleep apnea (adult/pediatric) 

- G47.36: You need to use this code to document sleep hypoventilation from other conditions 

- G47.01 & G47.33: Always use this code to document insomnia & obstructive sleep apnea (adult/pediatric) 

Now that you know about the commonly used codes in your sleep study billing services, you can ensure a perfect coding practice to enjoy timely reimbursements and elevated patient outcomes. You can also leverage professional third-party sleep study billing services if you lack a team of experienced and proficient coders. A perfect sleep study billing service always has a team of expert coders who know what it takes to ensure perfect coding without a single error.