Documentation must show that the polysomnography was performed in a facility based sleep study laboratory and not in the home or a mobile facility.
The sleep disorder clinic must have on file, in the patient’s record, documentation that narcolepsy symptoms are severe enough to interfere with the patient’s well-being and health before Medicare benefits may be provided for diagnostic testing.
If more than two nights of testing are performed, documentation justifying the medical necessity for the additional test(s) must be available in the patient’s medical record.
Documentation must show that the home sleep test (HST) were performed in conjunction with a comprehensive sleep evaluation and in patients with a high pretest probability of moderate to severe obstructive sleep apnea.
The patient who undergoes a HST must receive, prior to the test, adequate instruction on how to properly apply a portable sleep monitoring device. This instruction must be provided by the provider conducting the HST.
Documentation must show that the home sleep test was accomplished with a Medicare-approved device (e.g., description of channels monitored or clear indications of same included in the test report) and was performed by a physician meeting the training requirements listed in the “Coverage Indications, Limitations, and/or Medical Necessity Section”.
Parameters monitored and documented:
- Start time and duration of day/night of study.
- Total sleep time, sleep efficiency, number/duration of awakenings.
- For tests involving sleep staging: time and percent time spent in each stage.
- For tests monitoring sleep latency or maintenance of wakefulness testing:
- latency to both Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM) sleep.
- Individual sub-test sleep latencies, mean sleep latency and the number of REM occurrences on Multiple Sleep Latency Test (MSLT).
- Respiratory patterns including type (central/obstructive/periodic), number and duration, effect on oxygenation, sleep stage/body position relationship, and response to any diagnostic and/or therapeutic maneuvers.
- Cardiac rate/rhythm and any effect of sleep-disordered breathing on EKG.
- Detailed behavioral observations.
- EEG or EMG abnormalities.
The patient is to be referred to the clinic by the attending physician. The physician’s order must be kept in the medical record.
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Collop, N., Tracy, S., Kapur, V., & et al. (2011). Obstructive Sleep apnea Devices for Out-Of-Center (OOC) testing: technology Evaluation. Journal of Clinical Sleep Medicine 7(5):531-548.
Kushida, C.A., Littlner, M., Morgenthaler, T., & et.al (2005). Practice Parameters for the Indications for Polysomnography and Related Procedures: Update 2005. Sleep, 28 (4):499-519.
Michman, J., Morganthaler, T., & et.al. (June 2008). Diagnosis and treatment of obstructive sleep apnea in adults. Institute for Clinical Systems Improvement (ICSI). Health Care Guideline. pp. 1-54.
Morganthaler, T., Alessi, C., Friedman, L., & et al. (2007) Practice Parameters for the Use of Actigraphy in the Assessment of Sleep and Sleep Disorders: An Update for 2007. Sleep, 30(4):519-529.
Trikalinos, T., Ip, S., Raman, G., & et al. (August, 2007). AHRQ Technology Assessment; Home diagnosis of Obstructive Sleep Apnea-Hypopnea Syndrome. AHRQ Technology Assessment. 1-127.
Trikalinos, T., & Lau, J., (December, 2007). AHRQ Technology Assessment: Obstructive Sleep Apnea-Hypopnea Syndrome: modeling different diagnostic strategies. AHRQ Technology Assessment.