Pulmonology Coding Alert

Watch for more treatment criteria from CMS on the horizon. While some of Medicares sleep study guidelines are becoming more flexible, stay on guard for requirements that may soon tighten up more than you might like. Anticipate Stepped-Up Patient Compliance Notes Expect to see Medicare demanding more objective criteria that the patient is using prescribed therapy, such as CPAP (E0601, Continuous airway pressure [CPAP] device), consistently, predicts Robert Basner, MD, director of the Columbia University Cardiopulmonary Sleep and Ventilatory Disorders Center in New York, N.Y. You may see Medicare asking for documentation within a limited time frame that the patient is compliant in using his prescribed bilevel (E0471, Respiratory assist device, bi-level pressure capability &) or CPAP device (for instance, for four hours per night four times per week -- the standard for documenting patient compliance). Expect to Substantiate Treatment Benefits Dont be surprised if Medicare also starts pushing pulmonologists harder [...]