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Getting Inspire Therapy for Sleep Apnea Covered

Obstructive sleep apnea causes those who suffer from it to sleep poorly and always feel tired. Obstructive sleep apnea is also indicative for heart problems and complications. It is not a good idea to ignore obstructive sleep apnea and the potential problems that it may be causing to one’s body. Inspire Medical System’s Inspire® therapy […]

The post Getting Inspire Therapy for Sleep Apnea Covered appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Innovative Obstructive Sleep Apnea Therapy Coverage Expands

UnitedHealthcare, one of nation’s leading health plans, will provide coverage for Inspire, Inc.’s novel obstructive sleep apnea (OSA) therapy starting in August. This determination comes almost one year to the day after Aetna agreed to cover Inspire’s neurostimulation device. And over the past year, BlueCross BlueShield joined the movement and is now offering several plans […]

The post Innovative Obstructive Sleep Apnea Therapy Coverage Expands appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Sleep Apnea Device — E0486

We had our in-house denturist build a sleep apnea device for a patient that both myself and the patient were expecting the medical insurance to cover. This is my first attempt but I have been unsuccessful. Does anyone have experience billing a sleep apnea device to medical insurance? E0486 — Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment. Regence is denying as a non-billable to insurance. I bypassed billing Medicare as it is a dental device.

Any thoughts or suggestions are much appreciated!

Medical Billing and Coding Forum

Oral Appliance for Sleep Apnea

Our physician is interested in providing custom oral appliances for the treatment of obstructive sleep apnea. I have found the following codes related to this service.

Procedure Codes: D-9941 or L-8048/L-8043 (Unspecified Maxillofacial
Prosthesis provided by non-physician.)
Or K-0183 (Nasal applicator device used with CPAP.
CPT 21085- Complete Oral Appliance Therapy
CPT 21110- Used for all Oral Appliances, patient is responsible for
obtaining authorization prior to payment or receiving appliance.

AND

HCPC INSURANCE CODE:
21089 or 5999 Unlisted Maxillofacial Prosthetic Procedure
S8260 Oral Orthotic for treatment of sleep apnea,
Includes fitting, fabrication, and materials
S8262 Mandibular orthopedic repositioning device
E0485 Oral device/appliance used to reduce upper airway collapsibility, adjustable
or non-adjustable, prefabricated, includes fitting and adjustment
E0486 Oral device/appliance used to reduce upper airway collapsibility, adjustable
or non-adjustable, custom fabricated, includes fitting and adjustment

Have any of you used these codes successfully? Do the insurance carriers reimburse ENT for the DME related to this service? Any obstacles you are encountering on a regular basis?

Medical Billing and Coding Forum

Sleep Apnea – Medical Conditions That Causes Secondary Sleep Disorders

Some medical conditions can actually cause secondary sleep disorders. Aside from that, prescription medications used to treat your underlying medical conditions will cause you to develop secondary sleeping disorders. Such medical conditions would include gastroesophageal reflux disease, endocrine problems, cardiovascular diseases, kidney disorders, neurological problems and mental disorders, bone and joint problems such as arthritis, and respiratory problems.

Problems in the cardiovascular system can lead to sleeping disorders. These cardiovascular diseases would include congestive heart failure and coronary artery disease. In coronary artery disease, fat deposits accumulate in the walls of the blood vessels. These fat deposits are called as atheromas; thus, the condition being called as atherosclerosis. This condition would cause impeded blood circulation which leads to coronary artery disease. This condition would often lead to sleeping disorders such as sleep apnea. As for congestive heart failure, the patient’s heart is congested due to its inability to supply the requirements needed by the body; therefore, the heart’s workload is increased making it congested. Organs such as the kidney and the lungs are also greatly affected. Because of these conditions, the patient has a greater risk of developing sleep disorders such as obstructive sleep apnea.

Endocrine disorders such as thyroid gland problems and diabetes may also cause secondary sleeping disorders. In general, Diabetes can be considered as a multisystem disorder because it has a big impact on different body processes. Such processes would include metabolism of carbohydrates, proteins, and fats. Usually, restless leg syndrome is the sleeping disorder that occurs in people with diabetes. On the other hand, the thyroid gland is responsible for regulating the hormones that affect the level of energy in a person. Once the thyroid gland function is disrupted, major problems will likely occur. If there is an excessive secretion of hormones by the thyroid gland, the person would have episodes of waking up in the wee hours due to night sweats and will also have sleeping difficulties.

Aside from endocrine disorders, problems in the neurologic system can also lead to development of secondary sleeping disorders. Such neurologic problems would include epilepsy, Alzheimer’s disease, stroke, and Parkinson’s disease. Dementia and normal functioning is common among people with Alzheimer’s disease. Sleep fragmentation can also occur among people with Alzheimer’s disease. On the other hand, epilepsy is caused by electrical activities in the brain. Epileptic patients are at a greater risk to develop sleep disorder insomnia. As for Parkinson’s disease, it is a dysfunction in the central nervous system. People with Parkinson’s disease have motor problems and usually they suffer from tremors, muscle stiffness, posture problems, shuffling gait, and other normal activities. Aside from these motor problems, people with Parkinson’s disease are also predisposed to REM sleep behavior disorder and sleep onset insomnia.

Those who have respiratory problems such as chronic obstructive pulmonary disease and asthma are also predisposed to various sleeping disorders. Asthmatic patients have difficulties in breathing due to increased mucus production that causes airway obstruction as well as constriction and inflammation of the airway passages. Damage in the lungs that leads to difficulty in breathing is present in patients with chronic obstructive pulmonary disease. The most common sleeping disorder that these people develop are sleep fragmentation and often times, insomnia.

Mental problems such as bipolar disorder, schizophrenia, anxiety, and seasonal affective disorders are also prone to develop sleeping problems. These sleeping disorders would include sleep fragmentation and insomnia.

A condition called gastroesophageal reflux disease (GERD) is present among people who frequently experience acid reflux. Usually, the food that was previously ingested would regurgitate causing damage to the mucosal linings of the esophagus. For GERD, sleep fragmentation is likely to happen.

Problems in kidney functioning is troublesome because waste products are not eliminated. There will also be imbalances in the salt levels and water levels leading to serious problems like edema. Restless leg syndrome and insomnia are common among these people.

It is very evident that people with bone and joint problems are suffering from insomnia due to the fact that they are experiencing pain. An example of joint problem would be arthritis.

Secondary sleeping disorder is the term that is used to describe people who have sleep disorders caused by underlying medical conditions. When this happens, the best way would be to treat the medical condition first prior to treating the sleeping disorder itself.

Discover the the increasing face of sleep disorders in America as well as tips and basic lessons in understanding insomnia when you visit http://www.sleepdisordertherapy.com, the premier resource portal on sleep apnea.

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Medical Intervention For Sleep Apnea Treatments

There are many people that suffer from Obstructive Sleep Apnea. This can make not only their life hard, but it can infringe on the lives of those around the sufferer. Sleep apnea treatments come in many ways. They can be done through self help. The simple act of not taking the sedatives or not drinking the alcohol can, in fact give you a better nights rest. Any substance that may lead to overly relaxed muscles, especially of the neck, jaw and tongue, can cause one to suffer from obstructive sleep apnea. Other self help ideas include weight loss, if this is what needs to be done, maintaining regular sleep hours, sleeping on your side or sometimes the simple act of raising the head of your bed four to six inches will help decrease the incidence of sleep apnea.

If none of these ideas seem to help, then one must seek the advice of his or her primary care physician. Medically, sleep apnea treatments are very diverse. Following a sleep study to confirm the diagnosis of sleep apnea, your physician may suggest that you use CPAP at night. This is actually continuous positive airway pressure to help maintain an open airway throughout your night, thus preventing apneic spells. This is the most common treatment for obstructive sleep apnea. During the night, the sufferer will wear a small mask like structure over their nose. This is connected, through hoses, to a small machine about the size of a tissue box. There are many settings that maybe used and your physician will direct you in which is appropriate for your situation.

Although this is the most common treatment for obstructive sleep apnea, many find wearing this mask at night uncomfortable. These individuals may opt for looking into other sleep apnea treatments. If appropriate, there are dental appliances that maybe helpful, but usually only in mild cases. These appliances will either fit in your mouth or around your chin and head. There are mandibular repositioning devices or tongue retaining devices both of these help maintain an open airway throughout the night. A concern with these appliances is the effects they can have on your teeth.

If all else fails and your problem is sever and persists, there is the last ditch effort. These types of sleep apnea treatments are reserved for anyone that is unable to find relief through the other treatments listed above. Surgery is always the last thing anyone wants, because with it brings other risks including infection. But if nothing else will work and something needs to be done there is this option. Through surgical intervention they are able to either enlarge the airway, maybe by removing your tonsils and adenoids or reconstructing your jaw. These are usually used only as a last resort.

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Sleep Apnea Diagnosis

Issue: Physician is a specialist. Physician is asked, in consultation, to “evaluate for possible sleep apnea”
I am confused what the Dx. Should be.
The problem is listed in the Assessment/Plan:
-The Specialist’s consultation note has several diagnoses listed, with none of them being sleep apnea.
-Listed just below that is what looks like templated “Obstructive Sleep Apnea” with the referral for a sleep study.

I searched online if Sleep apnea can be the Dx. even if the pt. has not been tested for it yet.

I found a flow chart for “Sleep apnea diagnosis”. After going through symptoms such as snoring, Epworth sleep scale score, daytime sleepiness etc. the flow chart then states “Refer for Diagnostic Study to confirm diagnosis of Sleep Apnea”. It looks like Sleep Apnea can be the diagnosis even though a study has not been done yet.

I’m trying to see if I could code this as it. I know it’s not a very good note, and that I really should query the Physician.
Below is the note:

I’m seeing Patient in request of Dr. XXXXXX to evaluate for possible sleep apnea.
Patient states that she has had a history of waking up short of breath and gasping. This happens in all positions. She feels tired during the day. She believes that multiple family members have sleep apnea, though no one is on CPAP machine currently. She does have acid reflux which she takes ranitidine. She does wake up with headaches at times. She also wakes up with dry mouth at times. the most she has ever weighed is 20, 98 pounds. Her ESS is 0 out of 24.

ROS: Additionally reports: significant for GERD, dry skin, menstrual pain, she does take zolpidem for insomnia; otherwise negative review of systems

Physical Exam :
Patient is a 30-year-old female
Constitutional: General Appearance: morbidly obese. Level of Distress: NAD. Ambulation: ambulating normally.
Head: Head: normocephalic and atraumatic.
ENMT: Nose: no lesions on external nose, septal deviation, sinus tenderness, or nasal discharge and nares patent. Lips, Teeth, and Gums: no mouth or lip ulcers or bleeding gums and normal dentition. Oropharynx: no erythema or exudates and moist mucous membranes, tonsils not enlarged, and Oropharynx: Structures Visualized (Mallampati Classification): Class 4.
Neck: Neck: FROM, trachea midline, and no masses. Lymph Nodes: no cervical LAD, supraclavicular LAD, axillary LAD, or inguinal LAD. Thyroid: no enlargement or nodules and non-tender.
Lungs: Auscultation: no wheezing, rales/crackles, or rhonchi and breath sounds normal, good air movement, and CTA bilaterally.
Cardiovascular: Heart Auscultation: normal S1 and S2; no murmurs, rubs, or gallops; and RRR. Neck vessels: no carotid bruits.
Abdomen: Bowel Sounds: normal. Inspection and Palpation: no tenderness, guarding, masses, rebound tenderness, or CVA tenderness and soft and non-distended.
Musculoskeletal: Joints, Bones, and Muscles: no tenderness or bony abnormalities and normal movement of all extremities. Extremities: no cyanosis, edema, varicosities, or palpable cord.
Neurologic: Gait and Station: normal gait and station.

Assessment / Plan
1.–History of snoring and gasping at night associated with nonrestorative sleep; she is morbidly overweight; she has a Mallampati 4 airway. I suspect she has sleep apnea.
2.–Acid reflux for which she is on ranitidine.
3–C–section.
4. Obesity.
5–menstrual pain.
6–dry skin
1. Obstructive sleep apnea of adult
G47.33: Obstructive sleep apnea (adult) (pediatric)
2. Obstructive sleep apnea syndrome
G47.33: Obstructive sleep apnea (adult) (pediatric)
•SPLIT NIGHT SLEEP STUDY REFERRAL – Schedule Within: provider’s discretion Note to Provider: Split
A copy of this report was given to Physician XXXXX

Medical Billing and Coding Forum