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2017 Coding Essentials for Sleep Studies

Coding Essentials for Sleep Studies
Updated for 2017, this essential book includes coding information, CCI edit tables, payment tables, updates on OIG and RAC targets, support on split night study with CPAP titration, medical necessity requirements, ABNs and the revenue implications of home sleep testing coverage.

Price: $167.00



Effectively manage reimbursement for outpatient sleep studies.

Many sleep centers and hospital respiratory therapy departments don't understand reimbursement for outpatient sleep studies, especially medical necessity requirements. The rules are intricate, and the risks are big. We're here to help you achieve the proper payment and avoid auditor action. Besides learning the basics of coding, billing and reimbursement, you'll find out what the auditors are targeting and how to reduce the risk of repayment and penalties.

What's in this coding guide?

  • Chapter 1: Introduction
  • Chapter 2: Overview of Medicare Payment
    • Inpatient and Outpatient Services
    • Value-Based Purchasing
  • Chapter 3: Medical Necessity
  • Chapter 4: National Coverage Determinations
    • Sleep Disorder Clinics
    • Diagnostic and Therapeutic Services
  • Chapter 5: Local Coverage Determinations
  • Chapter 6: Advanced Beneficiary Notice
  • Chapter 7: National Correct Coding Initiative
    • Mutually Exclusive Procedures
    • Modifier Indicators
    • General and Specialty-Specific Correct Coding Policiess
  • Chapter 8: CPT® Modifiers
    • Modifiers 26, 52, and 59
    • Reporting on the UB-04 (CMS-1450)
  • Chapter 9: Evaluation and Management Services
  • Chapter 10: CPT Coding
    • Sleep Testing
    • Polysomnography
    • Penile Study
    • Home Sleep Testing
  • Chapter 11: Other Ancillary Services
    • Laboratory Tests
    • Pulmonary
    • Electroencephalograms
  • Chapter 12: Diagnosis Coding
  • Chapter 13: Documentation Requirements
  • Chapter 14: Bringing the Rules Together
  • Glossary and Resources
  • Appendix A: 2017 Payment Rates for Sleep-Related Procedures
  • Appendix B: Medicare Quality Payment Programs
  • Appendix C: Examples from Local Coverage Determinations: ICD-10-CM Diagnosis Codes That Support Medical Necessity
  • Appendix D: NCCI Edits for Sleep Disorder Studies
  • Appendix E: NCCI Edits for Related Laboratory Tests
  • Appendix F: NCCI Edits for Penile Studies
  • Appendix G: Sleep Referral Form
  • Appendix H: Recovery Audit Program
  • Appendix I: STOPBang Questionnaire
  • Appendix J: OIG Report: Questionable Billing for Polysomnography Services

CPT® is a registered trademark of the American Medical Association.