Don’t separately report a cursory H&P from the sleep code.
Question: If a nurse practitioner (NP) performed an H&P (history and physical exam) or a subsequent visit with a patient prior to a sleep study, can you bill the H&P with modifier 25 and the sleep study code? Is the H&P included in the sleep study?
Answer:
The visit has to be an evaluation for something other than scheduling a sleep study. It is fairly unusual that the pulmonologist would see the patient in the day time and conduct a sleep study on the same night. Because the sleep study would usually occur on a different day (and perhaps for a different reason), you should code 99201-99205 or 00212-99215 (Office or other outpatient visit, for the evaluation and management of an established patient) one day and 95811 (Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist) on a different day. Remember a NP should report the patient evaluation in her own name.
Note: A cursory H&P (immediately prior to initiation of the study) is not separately reported from the sleep code.
Another option: If the NP only saw the patient, then the NP would code 99201-99215 and the practice would receive 85% of the payment. The pulmonologist would code for the sleep study separately.
Be the hero. Join the coding community at Supercoder Fan Page.
Get the scoop on the value of customer service and how it leads to patient retention in the Power of Customer Service for Physicians and Staff audio conference.
