Cardio Sleep Review

Dedicated to the Nexus of Cardiology and Sleep Apnea Management

Issue 2,
November
2018

Hospital Coding with WatchPAT®️

by Melih Alvo
Director of Marketing

The WatchPAT® device has been given its own code, 98500, by the American Medical Association for reimbursement purposes. The following flowchart explains how physicians should report HSAT tests and associated procedures.

1. E&M NEW OR ESTABLISHED PATIENT VISIT (CPT® 99201-9925, 99211-99215)

  • During the patient visit, the risk of obstructive sleep apnea (OSA) is suspected and documented (ICD-10-CM G47.33)
  • Identify patients at risk of OSA with a STOP-BANG, Epworth Sleepiness Test or DOISNORE50 Test
  • Many commercial payers allow an E&M visit on the same date as 95800. Medicare will only allow an E&M code on the same date if it is for a separate and distinct reason

2. CONDUCT PATIENT VERIFICATION OF ELIGIBILITY AND BENEFITS

  • Medicare and most commercial payers cover 95800
  • Many but not all payers require prior authorization. Be sure to check the individual patient’s plan since benefits can vary within a payer’s plans. Include patient-specific diagnosis code(s), CPT code(s) and description of the procedure and anticipated date of service

3. CARDIOLOGIST PRESCRIBES HOME SLEEP TEST (CPT® 95800-TC)

  • Cardiology office educates patient on Home Sleep Apnea Test (HSAT) and dispatches the test for the patient to take home
  • For the WatchPAT® HSAT, the global code is 98500.
  • If the Cardiologist provides the test and interprets the results, report the global 95800 (only if Cardiologist is sleep certified)
  • If the Cardiologist

4. PATIENT CONDUCTS TEST AT HOME

  • The patient takes the test at home
  • Patient returns or ship back the device to the physician office

5. PHYSICIAN INTERPRETS RESULTS (CPT® 95800-26)

  • Sleep certified physician reads HSAT results and provides assessment
  • If the physician provides the test and interprets the results, report the global 9500 (only if the physician is sleep certified)
  • If the physician only interprets the results, report 95800-26

6. CARDIOLOGIST REVIEWS RESULTS AND TREATMENT PLAN WITH PATIENT (CPT® 99201-9925, 99211-99215)

  • Cardiologist reviews the results of the HSAT and treatment plan follow up with the patient • May schedule a follow-up visit in 3-6 months as needed

Note: Each payer has its own reimbursement requirements. Be sure to check for specific instructions. This flowchart is to be used as an example only.

REIMBURSEMENT INFORMATION

CPT® CODES
Report the following codes for commercial payers:

  • 95800 if you provide HSAT AND interpret the results
  • 95800-TC if you provide the test only
  • 95800-26 if you interpret the results only

ICD-10-CM CODES

  • G47.33 Obstructive Sleep Apnea
  • G47.30 Sleep Apnea, Unspecified

PLACE OF SERVICE (POS)

  • Place of Service is typically reported as POS 11 Office
  • Some payers request POS 12 Home • Always check with your local payer!

Itamar® Medical provides this information only for your convenience. It is not intended as a recommendation of clinical practice or as legal advice. It is the responsibility of the provider to determine coverage and submit appropriate codes, modifiers, and charges for the services rendered. Contact your Medicare Administrative Contractor (MAC) or other commercial payers for interpretation of coverage, coding, and payment policies.

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Cardio Sleep Review
Publisher: Itamar Medical
Editor: Melih Alvo

The Cardio Sleep Review editorial team thanks all those who contributed to this publication.

Itamar Medical, as the publisher of the Cardio Sleep Review, is not engaged in providing any specific medical advice or opinions on any medical symptom or condition.

Permission to photocopy editorial content is granted only for the “private and personal use” of the subscriber. Copying for any other use is expressly prohibited.

Itamar® Medical, PAT®, and WatchPAT® are trademarks of Itamar Medical or its affiliates. All other trademarks are held by their respective owners and are used for editorial purposes with no intention of infringement. All information contained herein is intended for guidance purposes only. Characteristics of the products and services can be changed at any time without notice. The Cardio Sleep Review strives to ensure all information is accurate, but shall not be responsible for typographical errors.

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