U.S. Range PS-4-20 Especificaciones descargar pdf (Pagina 50)

Respiratory Assist Device (RAD) Qualifying Guidelines

CMS guidelines February 2011

I. Restrictive Thoracic Disorders

Respiratory Assist Device (RAD)

Qualifying Guidelines

ABGs (done while awake)

PaCO

≥ 52 mm Hg

(patient’s prescribed FiO

)

Sleep oximetry

Oxygen saturation ≤ 88% for ≥ 5 minutes, minimum

2 hours recording time (on 2 L/min O

or patient’s

prescribed FiO

, whichever is higher)

OSA and CPAP

treatment has

been considered

and ruled out

CMS guidelines

February 2011

Respiratory Assist Device (RAD) Documentation Requirements for Continued Coverage

Patients on an E0470 or E0471 device must be reevaluated no sooner than 61 days after

initiating therapy.

Required Documentation

• Progress of relevant symptoms

• Signed and dated statement by treating physician declaring patient using average

4 hours per 24-hour period and patient beneﬁ ting from use

ResMed E0470 and E0471 Devices

E0470–Bilevel without a backup rate

• VPAP

™

Auto

• VPAP S

E0471–Bilevel with a backup rate

• VPAP ST

• VPAP Adapt

(E0470) or

(E0471)

Based on the treating

physician’s judgment

II. COPD

For COPD patients to qualify for a RAD with backup rate (E0471):

Situation 1

After period of initial use of an E0470; ABG (done while awake) shows PaCO

worsens ≥ 7 mm Hg compared to

original ABG result (on patient’s prescribed FiO

); PSG demonstrates oxygen saturation ≤ 88% for ≥ 5 minutes,

minimum 2 hours recording time, on an E0470, not caused by obstructive upper airway events (ie, AHI < 5).

(E0470)

Documentation of

neuromuscular disease

or severe thoracic cage

abnormality

Perform one of the following:

• ABGs (done while awake)

PaCO

≥ 45 mm Hg (patient’s prescribed FiO

) or

• Sleep oximetry

Oxygen saturation ≤ 88% for ≥ 5 minutes, minimum 2 hours

recording time (patient’s prescribed FiO

) or

• For neuromuscular disease only, either

FVC < 50% of predicted or MIP < 60 cm H

COPD does not

contribute

signiﬁ cantly to

pulmonary limitation

Situation 2

No sooner than 61 days after initial use of E0470; ABG (done while awake) shows PaCO

≥ 52 mm

Hg (on patient’s prescribed FiO

); Sleep oximetry on an E0470 demonstrates oxygen saturation

≤ 88% for ≥ 5 minutes, minimum 2 hours recording time (on 2 L/min O

or patient’s prescribed FiO

whichever is higher).

48 S9 VPAP Tx Lab System | Sleep Lab Titration Guide

ResMed.com

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