Hi talk2us@finetunegums.com!

Great questions - my responses below in bold!

1. Do the results of the sleep test need to be sent out to a sleep medicine specialist for a diagnosis?
Absolutely! The results of that test are basically just results until a sleep physician reads and interprets them. Many home sleep testing companies offer a portal that you an upload the results into for a sleep physician to read and interpret (provide diagnosis). Some professionals prefer to send the results to a local sleep physician in their area for reads.
If you bill for the home sleep test, but the results are not read by a sleep physician, you will want to make sure to use the modifier "TC" on the HST code when billed, which indicates that only the "technical component" was performed.

I was also told that we couldn't charge for both the appliance and the sleep test, we could only bill for one or the other....

2.Can we we bill for both the sleep test and the appliance if the appliance is of medical necessity?

This is true with Medicare for sure. Medicare does not allow a DME supplier to administer or bill for home sleep testing, and you have to be a DME supplier with Medicare to bill for the OSA appliance.
However many Private payers do not have policies surrounding that. It is best to check with the insurance company's medical policy for diagnosis and treatment of sleep apnea. I'm happy to help you locate the medical policies for the insurers in your region if you have any troubles.

Hope this helps! Let me know if you have any further questions!

Edited by user Tuesday, November 4, 2014 1:49:29 PM(UTC)  | Reason: Not specified

Hi Guest!

Great question! The short answer is: yes, most insurers will allow more than one sleep test as long as it is medically necessary.

The insurer's medical policy will generally outline if there are any limits, the qualifying criteria, etc.

Here's a good example for you, this is an link to Aetna's medical policy for diagnosis & treatment of OSA:
http://www.aetna.com/cpb/medical/data/1_99/0004.html

In the section of the policy that outlines criteria sleep testing (in-lab & home), the policy states:


It may be necessary to perform repeat sleep studies up to twice a year for any of the following indications (Note: where repeat testing is indicated, attended full-channel nocturnal polysomnography (NPSG) (Type I device) performed in a healthcare facility is considered medically necessary for persons who meet criteria for attended NPSG in section I above; in all other cases, unattended (home) sleep studies are considered medically necessary):

- To determine whether positive airway pressure treatment (i.e., CPAP, bilevel positive airway pressure (BiPAP), demand positive airway pressure (DPAP), variable positive airway pressure (VPAP), or auto-titrating positive airway pressure (AutoPAP)) continues to be effective; or

- To determine whether positive airway pressure treatment settings need to be changed; or

- To determine whether continued treatment with positive airway pressure treatment is necessary; or

- To assess treatment response after upper airway surgical procedures and after initial treatment with oral appliances.

Note: A home sleep study is performed over multiple nights with a single interpretation is considered a single sleep study for purposes of reimbursement.

Hope this helps! Let me know if you have any further questions!

Hi Robin!

Great question. The best way to do the SOAP notes from a follow up (titration/callibration) visit for an oral appliance for sleep apnea is to log the visit into the "sleep appliance adjustment follow up form", found on the list of available forms by using the yellow button on the visits/forms tab in any patient's chart in DW.

The sleep appliance adjustment follow up visit/form has a tab where you can track the patient's subjective progress and compliance with the appliance in the patient questionnaire tab (tab labeled "appliance use"), and any adjustment/exam item details can be logged into the "exam form" tab. When you make the SOAP note in tab #3 (recipients letters/reports) it will be a nice summary of the visit and progress.

Hope this helps, please let us know if you have any further questions!

Hi Dr. Gardner!

Great question. The answer is "it depends"!

The reason I say that, yes many dental practices we work with do bill private medical insurance for the home sleep study using one of the codes below, depending on what channels the home sleep test unit you have records:

95800 - Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time

95801 - Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone)

95806 - Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (eg, thoracoabdominal movement)

Having said that, you should always ensure that a board certified sleep physician interprets the results of that study, and be aware that there are some states (i.e. New Jersey) that deem home sleep testing outside of the scope of a dentist's practice.

Hope this helps, have a great day!

Hi guest!

A signed proof of delivery form is required for Medicare DME, and definitely not a bad idea (may even be required) for other medical insurers as well. We do have a proof of delivery form built right into the DentalWriter software.

If your office doesn't have the DentalWriter software, here is the language from the Medicare LCD for OAT for OSA that states what should be included in a proof of delivery form:

"Suppliers may deliver directly to the beneficiary or the designee. In this case, POD to a beneficiary must be a signed and dated delivery document. The POD document must include:
• Beneficiary's name
• Delivery address
• Sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description)
• Quantity delivered
• Date delivered
• Beneficiary (or designee) signature
The date delivered on the POD must be the date that the DMEPOS item was received by the beneficiary or designee. The date of delivery may be entered by the beneficiary, designees or the supplier. When the supplier's delivery documents have both a supplier-entered date and a beneficiary or beneficiary's designee signature date on the POD document, the beneficiary or beneficiary's designee-entered date is the date of service.
In instances where the supplies are delivered directly by the suppliers, the date the beneficiary received the DMEPOS supply must be the date of service on the claim."

Hope this helps, have a great day!