Is a Respironics DS 660 ES old technology

A couple of days ago LINCARE called me and said that Medicare had approved my doctors request to change from a ResMed S9 AutoSet CPAP to a Bilevel. I was supposed to go to my DME and be issued the machine yesterday, but put it off until my point of contact there returns from vacation. I look at ResMed to equate to a Chevy and a Respironics a Ford. I'm a Chevy guy. Hence my reluctance to accept what's being offered.

Anyway, I can no longer tolerate CPAP therapy due to such a large number of central apneas occurring each night. I had to take my sleep doc copies of color SleepyHead graph for the first week and last 3 nights before the light came on in his head that I might be onto something. In the meantime, I switched to my backup machine which is a ResMed S8 VPAP ST (first week of March 2014).

I had a sleep study done in 2010, and this lab saw my centrals and I ended up with a VPAP ST. Due to my being very claustrophobic, I didn't like the mask they gave me and never used the machine. I'm retired military and wasn't of Medicare age, therefore didn't have to prove to anyone that I was being compliant with the machine. TRICARE just paid the rental and eventually the machine was mine.

I had a sleep study done in early 2013, and this lab either didn't see the centrals, or the doctor, who only looks at the number range to determine if a patient is ok or not, didn't care. I was finally issued the S9 in Sept, and since I was of Medicare age. I had to comply with their standards to keep the machine, which I did, but at a cost which was somewhat effective therapy, but not good enough.

What I want to know is, is the machine (DS 660 ES) a current one, or could LINCARE do better. According to them, this machine is what the doc requested, and most of us understand how kickbacks work. I feel an S9 VPAP Auto, or ST would suit me.

The DS 660 machine is the current PR System One BiPAP PRO. It's a full data bi-level machine, but it is a fixed pressure machine---i.e. there is a fixed IPAP and a fixed EPAP. This is equivalent to the Resmed S9 VPAP S.

The next step up is the DS 760 machine, which is PR System One BiPAP Auto. Also full data, but has an Auto BiPAP mode. This is equivalent to the Resmed S9 VPAP Auto.

The 660 is NOT equal to the VPAP ST...neither is the model 760
The 660 is a fixed bilevel pressure machine....it doesn't auto adjust pressures at all.

Are you treating centrals or not now?

I bet the doctor didn't specifically say this model machine...you want the model 760 with auto adjusting pressures if you aren't dealing with centrals.
If you are dealing with centrals....you need a whole different model/type of machine.

apw5746 wrote: What I want to know is, is the machine (DS 660 ES) a current one, or could LINCARE do better. According to them, this machine is what the doc requested, and most of us understand how kickbacks work. I feel an S9 VPAP Auto, or ST would suit me.

Pugsy caught this and I didn't.

The S9 VPAP Auto and the S9 VPAP ST are very, very different machines and the S9 VPAP ST is the more expensive one which can "trigger" inhalations (and thus treat central apneas.) But the ST also has a fixed EPAP pressure as I recall. Only the IPAP varies and it varies only to trigger inhalations. Unless centrals are a known problem that you are trying to treat, there is no good reason to push for the S9 VPAP ST.

The S9 VPAP Auto cannot trigger inhalations, but it can auto adjust EPAP and IPAP in response to obstructive events. The PR System One BiPAP AUTO (model 760) is equivalent to this machine.

The S9 VPAP S cannot trigger inhalations and also is a fixed pressure machine. The PR System One BiPAP PRO (model 660) is equivalent to this machine.

Didn't you tell me that you felt better with using your VPAP S/T (it's a S8 model I think)
Didn't you tell me that you were getting a lot of centrals with your S9 AutoSet?

Pugsy wrote:Didn't you tell me that you felt better with using your VPAP S/T (it's a S8 model I think)
Didn't you tell me that you were getting a lot of centrals with your S9 AutoSet?

Yes, I was having many centrals when I was using the S9 AutoSet so I went back to the S8 VPAP ST and I slept much better. I'm waiting for my POC at LINCARE to come back Monday. Isn't the code E0601 for a CPAP (any brand) and E0470 for a BiLevel (any brand)? My POC is a CPAP user and I believe will help me out in a positive manner, but I won't hold my breath. Until I walk out of LINCARE with what I need, I'm not going to breath easily.

Pat

apw5746 wrote: Isn't the code E0601 for a CPAP (any brand) and E0470 for a BiLevel (any brand)?

E0601 is for cpap/apap machines....S9 Elite, Autoset, PR S1 Pro or Auto, or other similar brands with a single pressure.

Bilevel pressure machines have 2 available HCPCS code choices depending on what the machine will do.

E0470 for the "plain" bilevel machines without a back up rate. The PR S1 660/760 and the S9 VPAP S and VPAP Auto...will use this code.

ASV bilevel machines have a back up rate (that's what your S8 VPAP ST has) and a different HCPCS code
E0471

Google E0470 and E0471 medicare reimbursement codes and you will see what I mean.

If centrals are an issue...then that's why the back up rate on the VPAP ST S8 model machine lets you feel better...it's dealing with the centrals better.
I don't know if the "plain" bilevel machine would get the job done for you. For some people it can work if certain conditions are met and your body responds well. If there is any doubt though...I would push for the machine with the back up rate if I could get it done. Why buy another machine that might not work when you know for sure the back up rate machine works?

Pugsy wrote: If centrals are an issue...then that's why the back up rate on the VPAP ST S8 model machine lets you feel better...it's dealing with the centrals better.
I don't know if the "plain" bilevel machine would get the job done for you. For some people it can work if certain conditions are met and your body responds well. If there is any doubt though...I would push for the machine with the back up rate if I could get it done. Why buy another machine that might not work when you know for sure the back up rate machine works?

Strongly seconding what Pusgy is saying here.

If the S8 VPAP ST lets you feel better, you need to push for at least an S9 VPAP ST