OSA and CPAP Evaluation (Step-by-Step)

Obstructive Sleep Apnea Evaluation for CPAP: Step-by-Step Guide

At our recent faculty meeting we talked about the need to clarify how this gets done so that we can help patients in the most efficient way possible. The South Hills office has a work flow that is easy for them by placing referrals through MedCare which we are working to have available through TC. For now please utilize the following step by step.

Sleep Lab or Home Sleep Study Testing:
  1. Face-to-Face Visit (Office visit with a doctor) must occur first with face to face documentation so that we can place orders for durable medical equipment. Home sleep studies are DME related so one of the reasons they may not have been covered for some patients is that this was not met. You can also order sleep lab testing as below.
  2. Sleep study testing order: "Home Sleep Apnea Testing" (Dx: G47.32 Obstructive Sleep Apnea, even though they may not have this yet is fine) or polysomnography in sleep lab if you want the patient to do it in the lab
  3. Patient needs to have testing ordered. If they have UPMC, have Jane help you and the patient. If other insurance, patient can call their card number or can call the sleep lab.
  4. Patient completes testing and OSA is confirmed
  5. You can choose to order "Pap Nap" (type Pap Nap in EPIC) which can be done through the sleep lab. They help find and fit a mask for the patient even before ordering to set patients up well to be compliant (see below things to talk about section). This type of help can also be done through the DME companies as an alternative.
  6. Order CPAP (auto-titration)
  7. Patient needs to come back for a visit between 31-90 days: You should document use and benefit from the CPAP equipment.

Things to talk about with the patient:
  1. Testing needs to be done ASAP so that particularly if getting home study, the DME order is used within the right window (90 days)
  2. When CPAP is ordered it starts the clock on the insurance company checking on their compliance! They must use the machine at least 4 hours/night 70% of the time for a 30 day period (within in the first 90 days) or else the equipment will be taken away
  3. We have asked the division to formulate a handout/guide to the patient so that they are aware and less confused by the process as well.
I will update when I have more info from South Hills on their MedCare work flow!

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