Monday, November 24, 2008

More on Medicare Coverage of CPAP machines

A few weeks ago I posted on the subject of new medicare requirements for the coverage of a cpap machine.

An interesting part of the new requirements appears to mandate that the physician who will be prescribing the cpap machine see the patient prior to the initial psg:

INITIAL COVERAGE:A single level continuous positive airway pressure (CPAP) device (E0601) is covered for the treatment of obstructive sleep apnea (OSA) if criteria A - C are met:
The patient has a face-to-face clinical evaluation by the treating physician prior to the sleep test to assess the patient for obstructive sleep apnea.
The patient has a Medicare-covered sleep test that meets either of the following criteria (1 or 2):
The patient and/or their caregiver has received instruction from the supplier of the CPAP device and accessories in the proper use and care of the equipment.If a claim for a CPAP (E0601) is submitted and all of the criteria above have not been met, it will be denied as not medically necessary.

Currently most of the medicare patients who come through Somnus Sleep Clinic are referred directly for a polysomnogram, I see them after the polysomnogram. If they need cpap, I will typically schedule them for the titration study and then see them back again after that to prescribe cpap. I guess I need to start seeing patients with Medicare prior to their initial psg.

Thursday, November 13, 2008

Objective Compliance Documentation for CPAP use

A member of the AASM discussion boards provide a link to the following info regarding the new CMS requirements for the documentation of benefit of CPAP required for continued coverage of cpap beyond the initial 3 month period:

For PAP devices with initial dates of service on or after November 1, 2008, documentation of clinical benefit is demonstrated by:
Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved; and,
Objective evidence of adherence to use of the PAP device, reviewed by the treating physician.

I am planning on asking the durable medical equipment companies I work with to provide me with a compliance download for my Medicare patients. The Medicare patients will bring this printout to their appointments with me.

This LCD applies to most of the southern states, I believe that most other regions have similar LCD's.

The Consequences of Sleepiness

Excessive daytime sleepiness can lead to impaired work performance and motor vehicle accidents. It can also land you in jail:

An Israeli soldier got three weeks in the slammer for yawning during a ceremony this week to mark the assassination of prime minister Yitzhak Rabin, his mother said.

Wednesday, November 12, 2008

Medicare and CPAP

Along with allowing home limited-channel polysomnographic testing to qualify a patient for a cpap machine, CMS also instituted a 12-week trial period for cpap:

The use of CPAP is covered under Medicare when used in adult patients with OSA. Coverage of CPAP is initially limited to a 12-week period to identify beneficiaries diagnosed with OSA as subsequently described who benefit from CPAP. CPAP is subsequently covered only for those beneficiaries diagnosed with OSA who benefit from CPAP during this 12-week period.

This trial period applies whether osa was diagnosed by traditional polysomnography or by home testing.

I have heard from several sources that objective data will be required to demonstrate compliance (compliance download). Does anyone have any info about this, and when it will take effect (one source has told me Nov 1, 2008)???? If anyone could provide a link, it would be appreciated. thanks

Slow wave sleep and sleep apnea

In patients with OSA, apneas and hypopneas tend to be most frequent during REM sleep and the least frequent during slow wave sleep. The protective effect of slow wave sleep is something that I have observed when reading sleep studies, and I have heard several other doctors mention this. Apparently this is an area that has not been previously well researched, as there has been a recent study looking at this:

Slow-wave sleep (SWS) may have a protective effect for events related to sleep apnea, according to research presented at CHEST 2008, the annual meeting of the American College of Chest Physicians.