HCPCS codes - do YOU know what your rights are?

flylow · Post by **flylow** » Sat May 03, 2008 7:28 pm

Herre is a link for more codes

http://www.medicarenhic.com/dme/medical ... m_0308.htm

What is interesting about this is that it appears the frequency for new masks is 3 months but the frequency for head gear is 6 months but if you start buying this stuff ala carte, you wind up spending much more than buying a complete mask. No wonder everyone is confused about replacements. Every time I talk to my dme, he tells a different story.

GumbyCT · Post by **GumbyCT** » Sat May 03, 2008 8:50 pm

dllfo wrote:Some people might get by with one set of Swift Nasal Pillows, but my AVERAGE IPAP is 17+

I hit 30 cmH2O last night, a lot. My nasal pillows don't last long under high pressures. I think our DMEs on this forum mean well and are demonstrating that fact by being here.

For real ? You are using nasal pillows at pressures like that? My DME told me the limit was 14??

How do you like it? Does it dry your nose out? Flare your nostrils? Does the bipap make it more tolerable?
Tell me more - tell me more!!!

My pressures range from 14-20 on bipap so it around 18/15. I am using an Activa nasal mask, I like it but it tends to make my lips & gums sore, plus it is big, heavy, & loud.
I want to try the Aeiomed Headrest. Any thoughts?

dllfo · Post by **dllfo** » Sun May 04, 2008 3:43 am

Flylow, thanks for the links. I will add that to my growing list of Mediscare places.

Gumby CT, I am using the Swift II, with size large nasal pillows. and 2 LPM oxygen. The nasal pillows handle the pressure pretty well. I have hit 30 cmH2o so many times it is old news. My worst time was 30CMH2O for approx. 30 minutes straight. I am in solid apnea the whole time (Per Encore Pro).

I have had doctors and nurses tell me 20CMH2O is like a hurricane in your throat, then they ask if it hurts. I tell them no. My worst time frame with the mask was a 2+ hour nap about ten days ago. My Apnea was 47.2 for each hour.

What it all means is the machine is initiating a lot of breaths for me. The best bet for my problem is CCHS. I was born with it. I also have Vocal Cord Dysfunction (VCD) which combined with CCHS can be fatal.

My Vocal Cords sense GERD coming on, acid reflux is moving up my throat so the Vocal Cords slam shut to protect my lungs from the acid. Your Vocal Cords should open up and all is well. Mine don't. Heliox is the rescue agent for VCD. Anyway, I pass out (been there, done that, spent the day in Mercy San Juan's Critical Care Unit. Heart rate dropped into the 30s, so they put a nurse at the foot of my bed. I tried to tell them my heart rate is naturally low. Anyway, short version is....when YOU sleep, your CNS tells your heart to beat and your lungs should breathe for you. My brain, my CNS does not work and I stand an excellent chance of dying. This has been proven in two hospitals. Pretty frustrating.

It does not dry my mouth out if I sleep with it closed. Which I do.

Aeiomed mask? I tried it, it was "ok" but I went back to the Swift II. I have most of the masks made and my wife has tried all of them. I have tried most of them. My wife went back to the Swift I, but I still use the Swift II.
The Swift one is not as heavy on her lip. She is using the Respironics BiPap Auto and I use the Respironics BiPap Auto SV.

I had oral surgery April 10th, where they cut the skin off the roof of your mouth, then sew it to your gums. After the surgery I have 3 tooth aches all the time. Class II pain meds can stop the toothaches, but I get tired of being ... uh .... drugged most of the time. I am on the Oxycodone right now. I don't like the way it makes me feel, but the pain is worse.
I have one more surgery on the lower part, then we look at the upper gums. I drank drano when I was three.

I don't see which BiPap you are on, but your pressures are high enough to be uncomfortable unless you have a proper mask. I pull the straps tight and have minimal leaks. Do they have any idea why your pressures are so high? My apologies if you listed your equipment and I missed it. I have Min IPAP and Max IPAP. My IPAP average overnight is around 18.

My oxygen levels have dropped again, so who knows. Back to the National Jewish Hospital in Denver I guess. They are the best in the USA for ten straight years. They found the "hole" --- "the tear" in my heart and put an implant in to cure it. My oxygen levels went up to the 90s and I thought all was well. I guess not.

Did I answer your questions?? If not. please ask again.

xyz · Post by **xyz** » Sun May 04, 2008 3:54 pm

flylow:
> Here is a link for more codes
http://www.medicarenhic.com/dme/medical ... m_0308.htm

Everyone should bookmark this page. This is for Medicare, but most insurance plans just use this schedule for everyone because it's just easier to do that.

When your DMS BSs you, hand them a hardcopy of this page.

GumbyCT · Post by **GumbyCT** » Sun May 04, 2008 8:36 pm

dllfo - my Bipap is a Respironics 700M Series. and Yes you did answer my Questions. Thank You soo much.

Now I just have to convince the VA to order a Headrest so I can try it. The VA has a very limited choice in masks, tho the DME can order most anything. It just gets into whether it will work or even fit w/o trying it first.

My appt with the sleep doc is Tue. so wish me luck.
GumbyCT
ps. I am trying to get them to order an Aussie heated hose - they (& DME) never heard of it before.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, hose, DME

xyz · Post by **xyz** » Mon May 05, 2008 12:53 pm

> What is interesting about this is that it appears the frequency for new masks is 3 months but the frequency for head gear is 6 months

That is correct.

At the three month mark, tell your DME that you want the A7027/A7030/A7034 (nasal or FF, whatever). If they tell you you're not eligible until 6 months because it has the headgear (Apria will do this), tell them a) send it without the headgear and b) you'll report them to all appropriate authorities if they don't. What will usually happen is that they will send you the whole thing because they don't order the mask without the headgear.

> but if you start buying this stuff ala carte, you wind up spending much more than buying a complete mask.

You don't want to spend money for things the DMEs owe you under your insurance plan. You just want to insist that they obey the insurance rules. Write down the date, time, and name of the person and what they said.

raymart43 · Post by **raymart43** » Mon May 05, 2008 3:12 pm

I'm new to CPAP. Been using it for about a week now. I have a question about masks & insurance. I think my nasal mask is pretty good, but I would like to try out a full face mask because I'm definitely struggling a bit with having to keep my mouth closed. But I'm hesitant to "return" the nasal mask in case I end up like it better. Since the full face mask and the nasal mask are under different codes, would insurance cover a full-face mask before 3 months if the doctor prescribes it?

dllfo · Post by **dllfo** » Mon May 05, 2008 5:03 pm

Raymart 43,
I can't speak for your insurance, but mine gave me one of each. The tech who came out gave me a full face mask. I told him, due to medical reason, cannot use the FF mask. He insisted it was the best. I wore it about twenty minutes and tossed it into a corner. I called Apria at around 11pm, griping about the
^$%&#*% FF mask.

The next day they brought out a Swift Nasal Pillows mask and I have used it for the most part, every since then.

My lungs have damage from second hand smoke to the point I ... what is the word .... my lungs expell sputum 24/7. So a full mask wouldn't work.

I had to go out of town today, so Apria and I did not get to talk.