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Correct CPT Coding, Billing, and Documentation in Sleep Medicine

  • Barbara A. Phillips
Part of the Current Clinical Practice book series (CCP)

Abstract

The gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS) remains to be overnight polysomnography (PSG). A nocturnal PSG includes recordings of airflow, ventilatory effort, oxygen saturation, electrocardiogram, body position, electromyography, and electroencephalography. In standard, laboratory-based PSG, a technician is present for the entire study to completely monitor the patient. A single overnight study is generally sufficient to diagnose OSAS. In many instances, the level of Sleep-disordered breathing (SDB) is severe enough that the diagnosis of OSAS can be established early in the study. In this event, a “split-night” study may be performed, where the second half of the study is used to titrate treatment (positive airway pressure) for OSAS. The Centers for Medicare and Medicaid Services (CMS, formerly called the Health Care Financing Administration) has recently endorsed the performance of splitnight PSG but requires that the diagnostic portion of the test last at least 2 hours of sleep, to avoid artificially inflating the severity of the SDB. (See Appendix for sample split-night study protocol.)

Keywords

Obstructive Sleep Apnea Sleep Apnea Continuous Positive Airway Pressure Obstructive Sleep Apnea Syndrome Respir Crit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

General

  1. 1.
    American Academy of Sleep Medicine (2000) International Classification of Sleep Disorders (ICSD) [revised]. Diagnostic and coding manual. American Academy of Sleep Medicine, Westehester, IL.Google Scholar
  2. 2.
    Buysse DJ (2003) Clinicians use of the international classification of sleep disorders: results of a national survey. Sleep 26:48–51.PubMedGoogle Scholar

Diagnosis/Definitions

  1. 3.
    American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689.Google Scholar
  2. 4.
    Hosselet JJ, Norman RG, Ayappa I, et al. (1998) Detection of flow limitation with a nasal cannula/pressure transducer system. Am J Respir Crit Care Med 157:1461–1467.PubMedGoogle Scholar
  3. 5.
    Meoli AL, Casey KR, Clark RW, et al. (2001) Hypopnea in sleep-disordered breathing in adults. Sleep 24:469–470.PubMedGoogle Scholar
  4. 6.
    Stradling JR, Davies RJ (2004) Obstructive sleep apnoea/hypopnoea syndrome: definitions, epidemiology, and natural history. Thorax 59:73–78.PubMedCrossRefGoogle Scholar

Portable Monitoring

  1. 7.
    Chesson AL Jr, Berry RB, Pack A, et al. (2003) Practice parameters for the use of portable monitor-ing devices in the investigation of suspected obstructive sleep apnea in adults. Sleep 26:907–913.PubMedGoogle Scholar
  2. 8.
    Davila DG, Richards KC, Marshall BL, et al. (2003) Oximeter’s acquisition parameter influences the profile of respiratory disturbances. Sleep 26:91–95.PubMedGoogle Scholar
  3. 9.
    Golpe R, Jimenez A, Carpizo R (2002) Home sleep studies in the assessment of sleep apnea/hypopnea syndrome. Chest 122:1156–1161.PubMedCrossRefGoogle Scholar
  4. 10.
    Quan SF, Griswold ME, Iber C, et al. (2002) Short-term variability of respiration and sleep during unattended nonlaboratory polysomnography: the Sleep Heart Health Study. Sleep 25:843–849.PubMedGoogle Scholar

Prediction Models

  1. 11.
    Kushida CA, Efron B, Guilleminault C (1997) A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med 127:581–587.PubMedGoogle Scholar
  2. 12.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131:485–491.PubMedGoogle Scholar
  3. 13.
    Rowley JA, Aboussouan LS, Badr S (2000) The use of clinical prediction formulae in the evaluation of obstructive sleep apnea. Sleep 23:929–938.PubMedGoogle Scholar

Autotitrating CPAP

  1. 14.
    Ayas NT, Patel SR, Malhotra A, et al. (2004) Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep 27:249–253.PubMedGoogle Scholar
  2. 15.
    Hudgel DW, Fung C (2000) A long-term randomized, cross-over comparison of auto-titrating and standard nasal continuous airway pressure. Sleep 23:645–648.PubMedGoogle Scholar
  3. 16.
    Littner M, Hirskowitz M, Davila D, et al. (2002) Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. Sleep 25:143–147.PubMedGoogle Scholar
  4. 17.
    Massie CA, McArdle N, Hart RW, et al. (2003) Comparison between automatic and fixed positive airway pressure in the home. Am J Respir Crit Care Med 167:20–23.PubMedCrossRefGoogle Scholar
  5. 18.
    Randerath W, Schraeder O, Galetke, et al. (2001) Autoadjusting CPAP therapy based on impedance efficacy, compliance and acceptance. Am J Crit Care Med 163: 652–657.Google Scholar

Web Sites

  1. 19.
    CDC Web site. Available at: http://www.cdc.gov/nchs/about/otheract/icd9/abticdl0.htm. Describes ICD 10 and links to other relevant sites.
  2. 20.
    American Academy of Sleep Medicine. Available at: http://www.aasmnet.org. The primary advocate for sleep physicians and their patients.
  3. 21.
    Centers for Medicare and Medicaid Services. Available at: http://cms.hhs.gov/. Formerly called the HCFA. Cpap.Com Web site. Available at: http://www.cpap.com/.

References (Sample Letters 1 and 2)

  1. 1.
    He J, Kryger MH, Zorick FJ, et al. (1988) Mortality and apnea index in obstructive sleep apnea: experience in 385 male patients. Chest 94:9–14.PubMedGoogle Scholar
  2. 2.
    Wright J, Johns R, Watt I, et al. (1997) The health effects of obstructive sleep apnoea and the effec-tiveness of treatment with continuous positive airway pressure: a systematic review of the research evidence. BMJ 314:851–860.PubMedGoogle Scholar
  3. 3.
    Jenkinson C, Davies RJ, Mullins R, et al. (1999) Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnea: a randomized prospective parallel trial. Lancet 353:2100–2105.PubMedCrossRefGoogle Scholar
  4. 4.
    Peker Y, Hedner J, Norum J, et al. (2002) Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med 166:159–165.PubMedCrossRefGoogle Scholar
  5. 5.
    Suzuki M, Otsuka K, Guilleminault C (1993) Long-term nasal continuous positive airway pressure can normalize hypertension in obstructive sleep apnea patients. Sleep 16:545–549.PubMedGoogle Scholar
  6. 6.
    Hack M, Davies RJ, Mullins R, et al. (2000) Randomized prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance inpatients with obstructive sleep apnoea. Thorax 55:224–231.PubMedCrossRefGoogle Scholar
  7. 7.
    Findley L, Smith C, Hooper J, et al. (2000) Treatment with nasal CPAP decreases automobile acci-dents in patients with sleep apnea. Am J Respir Crit Care Med 161:857–859.PubMedGoogle Scholar
  8. 8.
    Loredo J, Ancoli-Israel S, Dimsdale JE (1999) Effect of continuous positive airway pressure vs placebo on sleep quality in obstructive sleep apnea. Chest 116:1545–1549.PubMedCrossRefGoogle Scholar
  9. 9.
    Engelman HM, Kingshott RN, Wraith PK, et al. (1999) Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159:461–467.Google Scholar
  10. 10.
    Bardwell WA, Ancoli-Israel S, Berry CC, et al. (2001) Neuropsychological effects of one-week continuous positive airway pressure treatment in patients with obstructive sleep apnea: a placebo-controlled study. Psychosom Med 63:579–584.PubMedGoogle Scholar
  11. 11.
    Redline S, Adams N, Strauss ME, et al. (1998) Improvement of mild sleep-disordered breathing with CPAP compared with conservative therapy. Am J Respir Crit Care Med 157:858–865.PubMedGoogle Scholar
  12. 12.
    Dimsdale JE, Loredo JS, Profant J (2000) Effect of continuous positive airway pressure on blood pressure: a placebo trial. Hypertension 35:144–147.PubMedGoogle Scholar
  13. 13.
    Akashiba T, Minemura H, Yamamoto H, et al. (1999) Nasal continuous positive airway pressure changes blood pressure “non-dippers” to “dippers” in patients with obstructive sleep apnea. Sleep 22:849–853.PubMedGoogle Scholar
  14. 14.
    Faccenda JF, Mackay TW, Boon N, et al. (2001) Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep-apnea-hypopnea syndrome. Am J Respir Crit Care Med 163:344–348.PubMedGoogle Scholar
  15. 15.
    Bahammam A, Delaive K, Ronald J, et al. (1999) Health care utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment. Sleep 22:740–747.PubMedGoogle Scholar
  16. 16.
    Engelman HM, Martin SE, Dreary IJ, et al. (1997) Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax 52:114–119.CrossRefGoogle Scholar
  17. 17.
    Harbison J, O’Reilly P, McNicholas WT (2000) Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive pressure. Chest 118:591–595.PubMedCrossRefGoogle Scholar
  18. 18.
    Sanner BM, Klewer J, Trumm A, et al. (2000) Long-term treatment with continuous positive airway pressure improves quality of life in obstructive sleep apnoea syndrome. Eur Respir J 16:118–122.PubMedCrossRefGoogle Scholar
  19. 19.
    Pepperell JCT, Ramdassingh-Dow S, Crosthwaite N, et al. (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359:204–214.PubMedCrossRefGoogle Scholar

References (Sample Letter 3)

  1. 1.
    Kribbs NB, Pack AI, Kline LR, et al. (1993) Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 147:887–895.PubMedGoogle Scholar
  2. 2.
    Massie CA, Hart RW, Peralez K, et al. (1999) Effects of humidification on nasal symptoms and com-pliance in sleep apnea patients using continuous positive airway pressure. Chest 116:403–408.PubMedCrossRefGoogle Scholar
  3. 3.
    Weist GH, Lehnert G, Bruck WM, et al. (1999) A heated humidifier reduces upper airway dryness during continuous positive airway pressure therapy. Respir Med 93:21–26.CrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2007

Authors and Affiliations

  • Barbara A. Phillips
    • 1
  1. 1.Department of Internal Medicine, Division of Pulmonary and Critical Care MedicineUniversity of Kentucky College of MedicineLexington

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