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need CPP or CPT code for resmed aircurve 10 ASV with oxymiter
#11
(04-24-2017, 03:59 PM)justMongo Wrote: I found the HCPCS code E0466 at a site Findacode.
At that site, I searched for "Adaptive Servo Ventilator".  There were several results.
I picked the one that was for use with a mask.
It's possibly incorrect; or, sometimes one HCPCS  covers several machines.  Like the code for a CPAP is the same as for a Auto PAP.

If they want the CPT code, then they want the code of an ASV titration.
They may decline to dispense without titration.

Thanks

I am finding all sorts of codes on many sites none of which are complete and up to date

I have found sites for AMA hippa various DMEs showing HCPCS CPT ICD and other codes 

What I am inferring is that ASV is too new and the codes have not caught up or they intentionally use the bipap code for ASV also 
and differentiate them on the Rx 

I am confused
how do you titrate an ASV ??  It sets itself automatically .  
Why cant they reuse the bipap titration if they need a starting point for the ASV machine.

The problem is that I do not sleep when the lab wants to run the tests.
We got only a 3 hour sample of data that the doctor said was inadequate last time but prescribed the bipap anyway.

I have all the justification and the Rx from the doctor for the ASV
I could just buy it without insurance.

MY insurance is DIFFERENT.   They have no 4 hour a night requirement.  All they need is an Rx accordign to what they told me.
The only question is the CPT code.  How does a titration test change the CPT code?  The code is the same for any pressures they set
but ASV has no set pressure.  

Why should I have to pay for and suffer through another torture session at the sleep lab.
I got a total of 3 hours sleep that night.  It took me two weeks to catch up and feel decent again.

And it took a three month wait to get into the lab AFTER the home PSG test.  

Delay expense and bureaucracy have exceeded my interest in getting a machine at all.


All the lady wants is a CPT code and does not care where it comes from.
#12
(04-24-2017, 04:25 PM)OpalRose Wrote: May I ask an obvious question here?

What insurance company, whether it be Medicare or any other insurance, doesn't already have the insurance codes needed for billing purposes?

Not to mention, if you are buying through a DME, they are the ones that bill insurance with the proper code.

The customer doesn't normally get involved with billing, (unless done incorrectly).

Now I'm not saying you shouldn't be informed and know the billing codes, but you shouldn't have to do their job for them.  

Just my 2 cents.

I have a BCBS plan from my old employer.

They have oodles of codes.
They just want someone to tell them the code for an ASV so they can look it up, see that it is covered, and approve payment. 

I told them to contact my DME but my DME makes it very hard for anyone to contact them for anything.
They are going to try that again tomorrow. 

This is not billing per se.  This is initial approval before I sign up for the ASV machine.  I have  bipap that is a total fail and must be returned first before I can get the ASV but that is another can of worms as my DME cant be contacted and has ignored emails. 

I agree I shoudl not be doing this but it seems to be the fastest way to cut through the krapp and get my machine.
Also to bypass a needless sleep lab study.  they want to make more money and my doctor has a financial interest in the sleep lab.  ethical?
dunno cant say but the doctor is excellent.  the lab is good when you can get to them.   but they like the DME have no way to be contacted.
#13
If they want a CPT, then that's a procedure code; and it would seem likely to be for an ASV titration.  You can Google what's involved in an ASV titration.
[Image: Screenshot_2_2.jpg]

If they want the billing code for the ASV machine -- it is the same as some other bilevel machines:
E0471
[Image: Screenshot_1_9.jpg]
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.


#14
(04-24-2017, 05:27 PM)justMongo Wrote: If they want a CPT, then that's a procedure code; and it would seem likely to be for an ASV titration.  You can Google what's involved in an ASV titration.
[Image: Screenshot_2_2.jpg]

If they want the billing code for the ASV machine -- it is the same as some other bilevel machines:
E0471
[Image: Screenshot_1_9.jpg]
That code matches what I can find on various sources that they use the same code for bipap and ASV



where did you find that diagram
on some DMEs site ?  

But i had a titration study
why do i need another one to switch mode from bipap to ASV
they should be able to use the same pressures to start at 
and the ASV adapts to the actual needs i have so titration is total waste anyway 

they gave me the cpt codes to get the bipap
why cant they just use them again

this bureaucracy is frustrating 

Thanks for helping me verify the code for the insurance to use to justify approval
#15
ASV machines are much more expensive than ordinary CPAP or even BIPap, so they probably want to make sure that: a) it is actually needed, and b) it will actually work for you. And they won't just take your word for it.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
#16
(04-24-2017, 07:56 PM)DeepBreathing Wrote: ASV machines are much more expensive than ordinary CPAP  or even BIPap, so they probably want to make sure that: a) it is actually needed, and b) it will actually work for you. And they won't just take your word for it.


original diagnosis had two codes

That is why they had two codes initially and gave me the bipap first under code E0470
it failed.

doctor confirmed that and wrote Rx for ASV type along with justification using the other initial code E0471.

part of the problem is DMEs trying to use medicare rules as a one size fits nobody on other insurance plans


#17
I'll go back to the question that Opal Rose asked and you haven't answered. Why do YOU need to provide these codes? Are you working thorough a DME? If so then they will supply the correct code.
#18
xxyzx, you've been given the answer multiple times and yet you keep demanding it isn't the right answer. You've even been given images with the right answer and yet it isn't enough.

Since you have gotten the answer you need and since this is going 'round and 'round with no progress, I've decided to close the thread.

Should you need further assistance, such as you actually submit the code and the insurance company (who as people said should already have it themselves) or the DME (who should be the ones submitting it and not you) say it is not enough (insurance companies like to say that since ASVs are expensive and they like the quibble over little things like codes), feel free to start another thread at that point in time.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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