Optum360 coding books logo
Optum360Coding.com
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
March 27, 2018


Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More


Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More


OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More


View Article Archive

Subscribe:
To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:
 

Medical Coding News Archives

CPAP for Obstructive Sleep Apnea Treatment Now Covered

 
August 26, 2008:

Continuous positive airway pressure (CPAP) based upon a diagnosis of obstructive sleep apnea (OSA) confirmed by home sleep testing (HST) is now covered by Medicare.

The Centers for Medicare & Medicaid Services has updated national coverage determination 240.4 to allow such coverage effective March 13, 2008. The CPAP must be for patients who have been diagnosed with moderate to severe OSA that has been confirmed by polysomnography (PSG) performed in a sleep laboratory or HST, and must be ordered and prescribed by a physician. 

Coverage of CPAP is initially limited to a 12-week period for beneficiaries diagnosed with OSA. CPAP is subsequently covered for those patients whose OSA improved as a result of CPAP during this 12-week period.

CPAP is covered for adult patients who have been diagnosed with OSA using clinical evaluation accompanied by a positive result for one of the following tests:

  • Polysomnography (PSG) performed in a sleep laboratory
  • Unattended type II home sleep monitoring device
  • Unattended type III home sleep monitoring device
  • Unattended type IV home sleep monitoring device measuring at least three channels

A positive test for OSA is established using the Apnea-Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI). The AHI or RDI must be greater than or equal to 15 events per hour or an AHI or RDI greater than or equal to 5 and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.

New HST Portable Monitoring Codes
CMS has also established the following HCPCS level II G codes to be used to report HST portable monitoring:

G0398  Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
G0400 Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels

Deborah C. Hall
Clinical/Technical Editor

 

 
Sign in to
Your Account
USERNAME
Forgot your username?
PASSWORD
Forgot your password?
Don't have an account?
It's easy to create one.

Promo code

Have a promotional source code? Enter it here:


What is this?

Code This!

Test your coding knowledge!

/VIEW MORE