Please need help today with reasons that husband should have ASV ..not ST

[mowork]

My husband's sleep doctor wrote a prescription for Resmed  AirCurve 10 St based on 2 sleep studies...the first showed  52% central apneas and 48% obstructive apneas with AHI of 65.2.  He then had a titration study where he only slept 153 minutes which showed few obstructive but mainly central apneas after doing several changes they decided 12/ 5 with 12 backup breaths per minute.  I do not have the studies.  I am getting copies tomorrow.  According to the DM he prescribed the Resmed  AirCurve 10 ST.  Someone said the ASV is better and the same price..if that it true...can someone give me some reasons to help me explain why I think an ASV would be better for him.  Keep in mind, he has never been on any machine, even a CPaP. ForMedicare tp approve a E0471 I thought you had to use a E0470 and show it didnt help you.  Maybe it is because in his documentation he said he needed backup. 

[mesenteria]

The diagnosis is one thing, but the titration might have shown that he doesn't need an ASV.  Regardless of what was determined, I think they start 'basic' with a machine that is fully capable, and they go through the types of treatment to figure out what regimen is going to be best, and maybe the ST sufficed.  I know, it seems stingy on the face of it, but without concrete information, including what they did to titrate him, we're whistling in the dark.

[mowork]

I don't have a copy of his tritration results.  I am supposed to get them tomorrow. But I got this summation off his patient portal:

"The patient did return for a CPAP/BiPAP titration study. The patient began the study on CPAP at 4 cm of water and was also studied on CPAP at 5 cm of water. There were no obstructive events but marked central events did persist. The patient was subsequently placed on BiPAP in the spontaneous mode and was studied on BiPAP and 10/5 and 11/5. No obstructive events were noted but central apneas did persist. The patient was subsequently placed on BiPAP with a backup rate at 12/5 and a backup rate of 12 breaths per minute. The apnea-hypopnea index did fall to 7.8. The patient did reach REM sleep and did have 4 obstructive hypopneas. The patient's oxygenation was adequate on the BiPAP therapy. There were no significant arrhythmias or limb movements"   

Any comments are appreciated. TIA

[Sleeprider]

The ASV is the correct therapy and won't cost a penny more. We have had many members that were prescribed ST ahead of ASV, and I think it worked out for only one member that ST was the correct solution. My advise would be to decline the ST and challenge the doctor's prescription, even if you have to get a second opinion.

Post the results of the study, and we will try to give you very specific suggestions on how to challenge the prescription, or perhaps accept it. In the absence of pulmonary disease, obesity hypoventilation or severe restrictive pulmonary condition, the ST is not the correct prescription. Here is a link to the rather long Resmed titration guidelines. I want you to read the intended use of the ST and ASV and make your own decision. The information you want to focus on is on pages 28 and 34. This is not my recommendation, but is the recommended use of these machine variations from the manufacturer. Use this information to argue in favor of the ASV. If your husband is issued a ST machine, you will be back asking for the ST. No apologies here, your physician is wrong, and will ultimately be proven wrong if you take the ST and inevitably fail.

Here is your future in the event you accept ST http://www.apneaboard.com/forums/Thread-...#pid292568

[mowork]

Is it possible that he is prescribing it because it is a Medicare problem? Keep in mind that my husband has never been on any kind of CPaP or BiLevel device before. Will Medicare just approve an ASV as the first machine?

[Sleeprider]

My understanding is that Medicare required an individual to fail on an E0470 (bilevel without backup) before approving an E0471 (bilevel with backup) device. Boh the ST and ASV are E0471, so my question is, why not just get the right one? This is a fair question for the doctor.

What I'm saying is that the billing code is identical anyway, just the specific device is different and has a different intended use. The ST is for pulmonary disease and the respiratory restriction resulting from COPD, neuromuscular deficiency or obesity hypoventilation. The ASV is for central and complex sleep apnea, including idiopathic centrals that your husband displays in his diagnosis. The ST is the wrong machine for the job, and accepting it will make it harder to get another E0471 ASV machine. The cost to Medicare and yourself is the same regardless of which E0471 device is purchased.

[ajack]

"The apnea-hypopnea index did fall to 7.8...did have 4 obstructive hypopneas"

That's a fail and needs to move to another machine for titration. ASV is the probable unit. You will need to look it up. Providing there are no lung type issues, but it's something like over 5 with the CA being the most with the OA/H under control, which it isn't. The timed breath is doing the CA and aren't showing.

If there are issues that exclude the ASV, I would ask to titrate in iVAPS or AVAPS, It should be better than ST mode