OK, now it's time for me to ask the questions...

[IllinoisRRT]

I know about the treatment for sleep apnea, but since I have never worked in a sleep lab, sleep studies are like a foreign language to me. I have a patient who was just retested for her sleep apnea. She did not qualify per Medicare guidelines the last time she was tested, but was retested. The sleep study report listed two AHI levels. One was 10.4, but then it said she did dramatically worse during REM sleep and had a AHI of 50-something. I think our billing department took the first one at first glance and denied her, but I wuld think she actually would qualify based on the second number. Does anyone understand this or care to explain?

Sidenote: the patient has had her CPAP this whole time at no charge, not to worry. The DME I work for isn't too evil

[rested gal]

Sidenote: the patient has had her CPAP this whole time at no charge, not to worry. The DME I work for isn't too evil

Excellent! We always knew you were a good'un, Christine. It's nice to hear your boss had sympathy for the lady's plight, too. I'd bet you gave a few little nudges in the right direction at opportune moments.

[IllinoisRRT]

Excellent! We always knew you were a good'un, Christine. It's nice to hear your boss had sympathy for the lady's plight, too. I'd bet you gave a few little nudges in the right direction at opportune moments. Smile

Well, we have a few that had sleep apnea bad enough to warrant a CPAP, but not bad enough to qualify for Medicare. It's a tough situation, because they don't get supplies replaced as frequently as someone who did qualify. But they get what they need. What I mean is, I really encourage our Medicare patients to take advantage of their new-mask-every-3-months benefit, but if Medicare isn't paying, we just give them what they need (obviously if a mask breaks or something they will get a new one). It's frustrating because we have some people who take advantage of this, wouldn't you know.

[ozij]

Hi Christine,
Resmed's Overview of Sleep, and the videos referenced in it should give you a good idea of sleep, sleep disrupted breathing, etc.

You are very right about your client: her sleep test shows that her breathing is highly disrupted whenever she enters the Rapid Eye Movement stage of sleep. This is when people dream. It is also a crucial stage for help and wellbeing, and therefore she should certainly qualify for treatment that will protect her breathing from disruptions at that stage. The breathing disruption at that stage.

Try to see if her oxygen saturation (or desat.) was reported specifically for her REM sleep, and also the length of her apneas at that stage - apneas are frequently longer, and desats worse in REM sleep - if that is the case with this patient you can use that also.

Good luck!
O.

[wading thru the muck!]

The AHI should be for the whole night and not just during a particular sleep phase. Does she have other medical conditions related to the apnea? Hypertension? Excessive daytime sleepiness? Diabetes? An AHI of 10.4 along with one of these other apnea related illnesses should qualify her for treatment.

[Guest]

The sleep study report listed two AHI levels. One was 10.4, but then it said she did dramatically worse during REM sleep and had a AHI of 50-something.

The AHI should be for the whole night and not just during a particular sleep phase.

I could be wrong but I believe it's common practice to list the overall AHI as well as a single stage AHI if that single stage represents a disproportionate distribution. In these cases it makes sense to represent both AHI numbers since that single most salient stage would also represent disproportionate physiological stress and risk.

When a single stage does happen to carry a disproportionate AH distribution, more often than not REM stage is the culprit.

[stetsongirl]

According to Medicare's own guidelines, If a person's AHI is between 5 and 15, the will qualify if they also are symptomatic ie. snoring, excessive daytime sleepiness, difficulty staying focused, etc.) It the AHI is over 15 they do not need to be symptomatic (although most usually are, isn't that why we had the sleep study to begin with?)

[rested gal]

Thanks for the clarification, stetsongirl. Good info.