Over the last few months, the American Academy of Sleep Medicine (AASM) has been closely working with the National Correct Coding Initiative (NCCI), a subsidiary of the Centers for Medicare and Medicaid Services (CMS), on its edits related to HCPCS level II codes G0398-G0400. The AASM, along with other national organizations, was able to review and submit comments pertaining to Medicare claims. The edits pair the G-Codes with those CPT codes describing services that would not be reported separately with the G-Codes when perform at the same patient encounter.

Though the NCCI consented with many of our recommendations, it did not accept all of them. Specifically, NCCI did not accept the AASM’s recommendation to define a Type IV monitor. In our comments to NCCI, we explained how the AASM views inclusion of Type IV devices as problematic since its lacks the definition for parameters which must be measured for a Type IV portable test. We asked NCCI to define Type IV with the following parameters: ventilation, respiratory effort and oxygen saturation. However, the AASM recommendation was not accepted.

The link below includes the edits that CMS will soon implement. CMS will also allow the use of modifiers with those edits where at least one organization submitted comment stating that the column two coded procedure could be performed on the same date of service at a separate patient encounter. To view the edits please visit www.aasm.org/resources/pdf/ncci.pdf.