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[Equipment] DME says they sent wrong machine - what’s the right one for my wife’s prescription?
#1
DME says they sent wrong machine - what’s the right one for my wife’s prescription?
the DME sent my wife an Aircurve 10 VAuto.

When she had her zoom call with them to set it up a couple weeks later, they told her they’d sent her the wrong machine. No further info, just “looks like you have the wrong machine, we can’t set this up today”.

I called the regional DME number (the national indicates a 30+ minute wait time no matter when I call).  The rep there was confused, didn’t see anything wrong, and then decided that because of her prescription she should have had an ST.

Her prescription sheet has a checkbox for the ST and it wasn’t used, the auto bipap was. 

Her prescription form says 
Diagnosis: G47.33
Machine type: E0740 (auto bipap)
Max IAP 25
Min EPAP 12
Min PS 4
Max PS 8
It also has two handwritten lines:
Min ISP 4
Max EPAP 20

She had no centrals in her studies so far as I’m aware. The sleep dr didn’t mention any, just talked about her oxygen levels. They had to crank the pressure up to 22 before her AHI reached a good level, so a bipap was prescribed. The fact that the mask the titration nurse said was a good fit leaked so much that she left the minute they had enough data because she couldn’t sleep well from all the noise it was making apparently wasn’t passed on to the dr or the leakage rate wasn’t considered significant.

Can anyone shed some light — which machine should she have, based on the prescription?

Thanks!

(As a side note, I had her using my airsense 11 vauto while she waited for the aircurve , and she was consistently between 1 and 4 AHI and her 99.5 was something like 14 or 16 once she switched from the leaky amara she came home with to an f30i and then an n30i. Wearing a wellue ring with it, the lowest oxygen reading we saw was 94% and most days 96% was the minimum.) 
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#2
RE: DME says they sent wrong machine - what’s the right one for my wife’s prescription?
The sleep study itself should tell the tale. If you/she has it, please read. If not, contact the lab and tell them you want a copy for your own personal medical file. They should provide it without complaint. If they balk at that, tell them you know it is your right under the HIPPA law to have your medical records. No debate about this. Feel free to be ugly if they hem and haw.
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#3
RE: DME says they sent wrong machine - what’s the right one for my wife’s prescription?
She has the correct machine. The ST is a fixed pressure with backup rate and it does not adjust pressure. The ST cannot be confibured to this prescription:
Her prescription form says
Diagnosis: G47.33 (obstructive sleep apnea)
Machine type: E0740 (auto bipap)
Max IAP 25
Min EPAP 12
Min PS 4
Max PS 8
It also has two handwritten lines:
Min ISP 4
Max EPAP 20

Several other pieces of information: The device type E0470 is a bilvel respiratory assist device without a backup rate. The ST is HCPCS Code E0471.
The prescription infers this is a Philips Auto BiPAP because it calls out a range for pressure support of 4.0 to 8.0. KEEP the Resmed and start with PS 4.0 and observe results.
To setup the machine use these settings:
Mode: Vauto
EPAP min 12.0
Maximum Pressure 20.0
PS: 4.0
The hand written lines may be suggesting starting with an EPAP min of 4.0, and capping IPAP at 20. Ask the doctor for clarification as I have not ever seen the notation ISP.

This will not be an ideal setting, but if you post results, we will help you get this tuned in properly. Your DME is clueless. Don't talk to them and let your doctor know they have no idea what they are talking about.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: DME says they sent wrong machine - what’s the right one for my wife’s prescription?
(09-27-2022, 09:00 PM)Sleeprider Wrote: I have not ever seen the notation ISP.

This is what happens when you work in IT -- IAP gets autocorrected to Internet Service Provider. Sorry for the confusing bit.

We're contacting her sleep doctor. The only thing on the prescription that doesn't match what she got was the mask - it said full face and they sent her an Eson2 nasal. It works much better than the Amara she got during the titration, though, so she wasn't complaining - she actually likes it better than the N30i she ordered.
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#5
RE: DME says they sent wrong machine - what’s the right one for my wife’s prescription?
update - when I talked to the DME rep a few days ago, he said that she actually needs an ASV, not an ST.  Huhsign Perturbed

going to call the sleep doctor's office tomorrow, and if I can't get the nurse who's supposed to be dealing with them on the phone -- I was promised 3 times in the last 2 weeks that she would call me back and she has not -- I'll probably drive over there and see if I can get anyone to actually help when I'm there in person, because the DME's "deadline" to return the device is 10/25.

I created a therapy thread for her with a couple of nights data using the aircurve vauto, with AHIs of 0.69 and 2.27, so... yeah.
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#6
RE: DME says they sent wrong machine - what’s the right one for my wife’s prescription?
ASV is a whole different ball game, and usually a different diagnostic code. Will take a look at the new thread.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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