Primary Care Coding Alert

Question: A patient with sleep apnea was fitted for a continuous positive airway pressure (CPAP) machine, and they come in for a follow-up. The provider determined the patient’s compliance by downloading the smart card of the CPAP. Would this be included as ordering a procedure or independent interpretation when determining the level of medical decision making (MDM)?

New York Subscriber

Answer: This would not likely count as either the ordering or independent interpretation of a test, and therefore would not be counted toward MDM. Here’s why.

The card download helps the provider assess patient compliance. This is for the sake of insurance coverage and possibly additional safety reasons. Depending on the severity of the patient’s condition, compliant use of the CPAP might be required to maintain a driver’s license, for example. The issue here is that CPAP is a method of treatment, but it’s not a diagnostic test or tool. As such, ordering the CPAP is not considered ordering a test nor is downloading the associated smart card the independent interpretation of a test.