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We have a patient that was diagnosed in 2009 with sleep apnea but does not wear his CPAP. When he was in for his cleaning and wants to have an oral appliance made. We do not have a referral from his MD or sleep dr. for the appliance. Is it OK for us to go ahead and make the appliance, and if so, do we use a different exam code?
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Rank: Advanced Member
Joined: 9/10/2012(UTC)
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It is recommended that you contact the insurance company and find out what the time span is on how recent the sleep study should be. Some carriers do not have a specific time limit but would want documentation stating whether or not there are any changes regarding the patient's health status. You will also want to inquire whether or not the patient needs a face to face with a physician. Dr. Tucker has stated he would not place an oral appliance for OSA without a written order from a physician, so I would bet one.
When you have the patient back for a sleep history, exam and workup for an oral appliance, that is when you bill for the established patient exam.
Hope this helps,
Rose Nierman
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