Hi Robin!

Great questions, my responses below:


In looking in to the change in ICD and corresponding CPT codes it seems that now insurance companies are approving 97762 for the follow-up appointments to an oral appliance deliver. Although some still accept the eval and management codes in the 99211 series. Which is appropriate when?
In my opinion, the E&M codes (99211-99215) would be more appropriate for for visits that include additional history collection, examination, or medical decision making, and the 97762 would be more appropriate when it is more of a straightforward appliance check/adjustment.
The reason i say that, for the E&M codes, they require when used that at least of 2 of 3 of the elements of an exam be completed and documented. (the elements being history collection, examination, or medical decision making). Here are more detailed descriptions of 99211-99215:

99211 - Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.

99212 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.

99213 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.

99214 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.

99215 - Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family


As well it seems now that a certain number of adjustments are considered part of the E0486 claim - any standards on this? As well what are the included, the 97762 or the eval and management codes?
Yes we have been seeing that more and more over the past few years, especially since Medicare made that part of their LCD for oral appliances for OSA. The general rule of thumb here is that if the insurer does consider follow up care included in E0486, it is usually a 90 day period. (although i have seen policies that will include longer than that, like 6 months to 12 months!.....those are very rare, 90 days seems to be the average since that is Medicare rules). And for those, it probably would not matter if an E&M code or 97762 was used, because they indicate all care related to the oral appliance is considered included.


Secondarily - is there still an ICD diagnostic code in use such as the 780.53, or 780.51 that a dentist can use as additional diagnostic code for sleep apnea, which I thought a dentist could diagnose and a MD had to diagnose the 327.23 now G47.33?
Yes you are correct, a physician must provide the diagnosis of OSA, which yes is G47.33 for the new ICD-10 codes. A dentist may use diagnosis codes representing symptoms, like snoring for example.
Some additional ICD-10 diagnosis codes that may be used for sleep patients:
R53.83 - Other fatigue
R06.83 - Snoring
G47.10 - Hypersomnia, unspecified
G47.63 - Sleep related bruxism
G47.30 - Sleep apnea, unspecified
G47.8 - Other sleep disorders
G47.9 - Sleep disorder, unspecified
G47.69 - Other sleep related movement disorders

Hope this helps!