tci Part B Insider - 2005 Issue 18

Part B Coding Coach: Sleep Easy With These 4 Sleep Apnea Coding Steps

Hint: Obtain pre-authorization before the lights go outIf your practice doesn't manage carrier-specific guidelines when trying to diagnose and treat a patient who may have sleep apnea, you could wake up to pre-authorization and claims denials. There is no National Coverage Determination (NCD) for sleep disorder testing, so you must check your carrier's Local Coverage Determination (LCD) or other billing guidelines to know the exact coverage requirements.Follow these four steps to maximize your success with sleep apnea testing claims:1. Determine sleep apnea type. Sleep apnea falls under ICD-9 series 780.5x (General symptoms; sleep disturbances). The diagnosis is...

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