U.S. Range PS-4-20 Especificaciones descargar pdf (Pagina 51)

Improvement of sleep-associated hypoventilation with

use of E0470 or E0471 device on:

• Settings that will be prescribed for

initial use at home

• Patient’s prescribed FiO

A diagnosis of central sleep apnea (CSA)

requires all of the following:

1. An apnea hypopnea index > 5

2. Central apneas/hypopneas > 50% of

the total apneas/hypopneas

3. Central apneas or hypopneas ≥ 5 times

per hour

4. Symptoms of either excessive

sleepiness or disrupted sleep

This information is provided as of the date

listed, and all coding and reimbursement

information is subject to change without

notice. It is the provider’s responsibility

to verify coding and coverage with payors

directly. For a full description of the policy

go to www.cms.hhs.gov.

ResMed reimbursement hotline, dial

1-800-424-0737 and select option 4.

(E0470) or

(E0471)

Based on the treating

physician’s judgment

Complex sleep apnea (CompSA) is a form of central apnea

• Identiﬁ ed by the persistence or emergence of central apneas or

hypopneas upon exposure to CPAP or an E0470 device when

obstructive events have disappeared

• CompSA patients have predominately obstructive or mixed apneas

during the diagnostic sleep study occurring at ≥ 5 times per hour

• With use of a CPAP or E0470 device, they show a pattern of apneas

and hypopneas that meets the deﬁ nition of CSA

III.

Central Sleep Apnea or Complex Sleep Apnea

IV.

Hypoventilation

ABGs (done while awake)

PaCO

≥ 45 mm Hg

(patient’s prescribed FiO

)

• ABGs (done while awake)

PaCO

worsens ≥ 7 mm Hg compared to ABG result used to qualify for

E0470 (patient’s prescribed FiO

) or

• PSG demonstrates oxygen saturation ≤ 88% for ≥ 5 minutes, minimum

2 hours recording time, on E0470, not caused by obstructive upper airway

events (ie, AHI < 5)

(E0471)

Covered E0470 being

used

Spirometry

FEV1/FVC ≥ 70% and an

FEV1 ≥ 50% of predicted

Refer to SEVERE COPD category for

information about device coverage

for patients with FEV1/FVC < 70%

or FEV1 < 50% of predicted

(E0470)

• ABGs (done during sleep or immediately upon awakening)

PaCO

worsened ≥ 7 mm Hg compared to original ABG

(patient’s prescribed FiO

) or

• PSG demonstrates oxygen saturation ≤ 88% for ≥ 5 minutes, minimum

2 hours recording time not caused by obstructive upper airway events

(ie, AHI < 5)

Dx: Central sleep

apnea or complex

sleep apnea

Full PSG,

attended in

sleep lab

Spirometry

FEV1/FVC ≥ 70% and an

FEV1 ≥ 50% of predicted

Refer to SEVERE COPD category for

information about device coverage

for patients with FEV1/FVC < 70%

or FEV1 < 50% of predicted

Lab Support 24/ 7 (888) 288-6738 | Sleep Lab Titration Guide 49

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U.S. Range PS-4-20 Especificaciones Pagina 51

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