U.S. Range PS-4-20 Especificaciones descargar pdf (Pagina 47)

S9 VPAP Adapt Reimbursement Coding

MD – sleep specialist

ICD-9 Codes

327.21 Primary CSA*

327.22 CSA due to high altitude periodic breathing

327.26 Sleep-related hypoventilation/hypoxemia in

conditions classiﬁable elsewhere

(requires underlying diagnosis code)

327.27 CSA in conditions classiﬁed elsewhere

(requires underlying diagnosis code)

786.04 CSA due to CSR

* Most commonly used for complex sleep apnea patients. These are examples of

diagnoses that may be associated with the above mentioned technology. Physicians

must determine the appropriate ICD-9 diagnosis based on individual patient needs

during the initial exam or through a history and physical.

CPT Codes

95810 PSG; sleep staging with four or more additional

parameters of sleep, attended by a technologist

95811 PSG; sleep staging with four or more additional

parameters of sleep, with initiation of continuous

positive airway pressure therapy or bilevel ventilation,

attended by a technologist (94770 carbon dioxide,

expired gas determination by infrared analyzer)

CPT

is a trademark of the American Medical Association

Prescription for S9 VPAP Adapt

HCPCS Code

E0471 Bilevel w/ backup rate

Deﬁnitions

Respiratory Insufﬁciency – Impairment in respiratory function

severe enough to prohibit certain activities that the patient might

normally pursue, and to interfere with daily living; occurring in

association with measurements of respiratory mechanics and/or

gas exchange that are markedly abnormal.

Complex sleep apnea (CompSA) is a form of CSA speciﬁcally

identiﬁed by the persistence or emergence of central apneas or

hypopneas upon exposure to CPAP or an E0470 device when

obstructive events have disappeared. These patients have

predominantly obstructive or mixed apneas during the diagnostic

sleep study occurring at greater than or equal to ﬁve times per

hour. With use of a CPAP or E0470, they show a pattern of

apneas and hypopneas that meets the deﬁnition of CSA.

CSA is deﬁned as:

(1) An apnea–hypopnea index greater than ﬁve; and

(2) Central apneas/hypopneas greater than 50% of the total

apneas/hypopneas; and

(3) Central apneas or hypopneas greater than or equal to

ﬁve times per hour; and

(4) Symptoms of either excessive sleepiness or disrupted sleep.

References

1 Centers for Medicare & Medicaid Services, “LCD for Respiratory Assist Devices (L11493)”

U.S. Department of Health and Human Services, http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_

id=11493&lcd_version=22&show=all (revision effective date 4/01/2006) Current Procedural Terminology

relative values, relative values, or related listings are included in CPT. The AMA assumes no liability

for the data contained herein Applicable FARS/DFARS restrictions apply to government use.

MD – Primary care physician

ICD-9 Codes

Sleep-related breathing disorders, hypersomnias, circadian rhythm sleep disorders,

parasomnias, sleep-related movement disorders (a listing of ICD-9 codes related to

sleep disorders can be found in the ResMed Reimbursement Manual)

EXAMPLE: 780.54 Hypersomnia, unspeciﬁed

* It is important to note that Medicare will not recognize all codes as medically necessary for sleep disorder

testing. Medicare most commonly accepts diagnoses of sleep-related breathing disorders, narcolepsy,

parasomnias and impotence.

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