Coding Articles
In response to advocacy by the American Academy of Sleep Medicine and other medical organizations, Cigna has agreed to pause its automatic downcoding policy — Evaluation and Management (E/M) Coding and Accuracy Policy (R49) — effective Oct. 1, 2025. In the AASM’s letter [...]
By the Coding and Reimbursement Advisory Committee Remote monitoring services refer to the use of digital technologies to collect, transmit and analyze health data from patients outside of traditional health care settings, such as in their homes. These services enable health care professionals [...]
On June 9, 2025, the Centers for Medicare & Medicaid Services (CMS) published a national coverage determination (NCD) memo for noninvasive positive pressure ventilation (NIPPV) in the home for chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD). This decision introduces [...]
Hypoglossal nerve stimulation for treating obstructive sleep apnea (OSA) became a viable clinical option following its FDA approval in the United States in 2014. Sleep medicine providers will typically bill codes 95970, 95976 and 95977, which are used for the programming and analysis [...]
The American Academy of Sleep Medicine (AASM), along with the American Academy of Neurology (AAN), American Thoracic Society (ATS), and American College of Chest Physicians (CHEST) is participating in a joint AMA/Specialty Society Relative Value Scale Update Committee (RUC) survey on the codes [...]
The sleep medicine phrenic nerve stimulation codes became effective Jan. 1, 2024. They were created because of advances in phrenic nerve stimulation technology, improved diagnostic precision, and recognition of clinical needs in sleep medicine, all of which facilitated reimbursement and payer clarity. The [...]
In the 2021 Medicare physician fee schedule final rule, the Centers for Medicare & Medicaid Services (CMS) added a new Healthcare Common Procedure Coding System (HCPCS) code, G2211, as a reimbursable service. This code reflects visit complexity and increases the value of office and [...]
The AMA Current Procedural Terminology (CPT) guidelines for split or shared visits were recently updated and implemented as of Jan. 1, 2024. These revisions aim to clarify and streamline the billing process for split or shared evaluation and management (E/M) services, ensuring clarity on [...]
This edition of Coding Quarterly highlights appropriate coding for oximetry to capture both practice expense and physician work as well as review of evaluation and management (E/M) coding.Coding scenarioMr. Smith, an established patient, was recently diagnosed with severe sleep apnea by a home sleep [...]