Any One Hear of This ????

[djr1215]

CPT stands for "Current Procedural Terminology." (whatever THAT means! LOL!!)

CPT codes are what are billed to your insurance company for visits and procedures. For instance, polysomnography is billed with codes 95808, 95810 or 95811 depending on how many parameters are checked and whether or not CPAP is started. Sleep studies are coded using 95805 and 95806. Those are all category I CPT codes. Now we also have category III codes 0203T and 0204T for products like the Watch-PAT.
On this forum you are more used to HCPCS codes. HCPCS stands for Healthcare Common Procedure Coding System (The H used to stand for HCFA before HCFA changed their name to CMS). CPT codes are Level I HCPCS codes. What are normally called HCPCS codes are actually Level II HCPCS codes. Because CPT does not cover supplies and devices, HCFA (now CMS) developed HCPCS Level II codes for that. There are also a few Level II HCPCS codes for procedures that do not have a CPT code or that CMS wants more specificity than is in the CPT code. While CMS develops the HCPCS Level II codes, they can be used by any payer.

[Janknitz]

Yep, that's right, it's the Itamar Watch PAT. PAT stands for "peripheral arterial tonometry". I used an older model with a heavier unit that had to attach to an arm brace. There was a chest strap, too, but we (Kaiser does everything in groups) were instructed not to use it. I think there was one truck driver in our group, and he had to use the chest strap.

For straightforward cases of sleep disordered breathing, IMHO, this testing is fine. It clearly showed what you need to know for simple OSA. I am not sure how Kaiser deals with more complex cases like PLMD, mixed apneas, UARS, etc, and whether they even notice them. Kaiser also does home titration via PR S1 autos, and perhaps they further test people who don't have much improvement on PAP alone. Or maybe they don't--you never know with Kaiser.

There's something to be said for a home study. I read so many reports of people who got so little or no sleep under the sleep lab conditions that their studies can't possibly reflect what is going on with them. Many never reach REM sleep because they are too uncomfortable to ever go into a deep sleep. I would have been one of those people--I never could have slept under those conditions.

Instead, I was able to put this device on my two fingers, strap the unit to my arm, and sleep in my own bed and sleeping conditions. I slept fairly well that night, and I think that we got a pretty accurate picture of my straightforward OSA. The only thing I didn't have was somebody telling me to roll onto my back so that we could see my AHI go even higher than 77 per hour and watch my 02 drop below 73.

[Janknitz]

I'm skeptical that there's any money to be saved, though. Even though the diagnostic procedure may cost less, if more patients are diagnosed, expenditures for treatment have to go up.

Kaiser is an interesting care model in that it is both the provider and the insurer. For that reason, Kaiser has a vested interest in treating SA, because they will save money downstream by reducing the risk of diabetes, cardiovascular disease, and other sequelae of untreated apnea.

It has to very cost effective for Kaiser. My local Kaiser probably tests about 50 or 60 people each WEEK using the Itamar PAT test. The entire "sleep lab" staff consists of 4 RT's, and nobody has to work at night (no shift differentials!). At least 50% of the people tested (my guess) are diagnosed with sleep apnea and sent home with System One Auto machines for home titration. The RT's run group classes to instruct people on how to use the home test, and then how to use the machines for home titration. Kaiser owns the testing equipment and the auto machines used for home titration (you take it home for a week without a humidifier ). It's a very efficient operation.

Kaiser also has some sweetheart deal with Crapria. Kaiser RT's do all the mask fittings and determine what machine you will get (auto or straight CPAP) and then all Crapria does is fill the orders. Crapria does a huge volume from all the Kaisers in the region, and in return must heavily discount the machines and supplies to Kaiser. Kaiser has a limited formulary for masks, probably to make it easier on Crapria. Crapria never has to see or talk to a patient--the centralized regional DME for Kaiser does all the ordering and ALL equipment is mailed to the patient. If you do have the misfortune to have to call Crapria, they are rude and make it clear that they are not happy because they don't make much money off an individal Kaiser patient (though they must make a mint in volume alone).

[Mr Capers]

Hi Everyone,

My sleep study was at home. I had a finger-tip pulse oximeter, chest band, and a few other sensors. My AHI was 35. I fought for, and got, a full PSG and my AHI was 85! I suggest that the take home sleep studies are good for a coarse-grained study and probably OK for a very uncomplicated OSA. They can provide pointers that a problem exists.

If you have a more complex set of issues, then a full PSG is a really good idea.

My INMHO,
Mr Capers

[Amigo]

If this can be done "inexpensively" (compared to the thousands a full-blown PSG costs), and benefit those who might otherwise slip through the cracks, I'm in favor.

Granted, some may require a complete PSG in a hospital or sleep clinic for more troublesome issues, but isn't some treatment for sleep apnea better than none at all?

...and EVERYONE who is diagnosed/treated in this way should be told to go to cpaptalk.com immediately.

[BlackSpinner]

I also had a home study with chest band, things up the nose and finger clip and arm/wrist band. It is the first line of OSA detection here. Then you get a take home titration test a month later (in the mean time you get a cpap machine set to an approximated level to get you used to using it) I know others who had a full blown PSG study after due to issues seen (or not seen) on their at home studies. The home study was cheap, easy and comfortable.