Tips for Coding Snoring and Sleep Apnea
Estela Vargas, CRDH, CEO Remote Sourcing
Walking in your sleep around coding these procedures?
Is it Snoring, or is it Sleep Apnea? Dentists usually see patients with both issues and their similarities however, they are not the same and are treated differently.
Snoring is the guttural sound that occurs when air flows past throat tissues, causing the tissues to vibrate as you breathe. Most people snore occasionally but for some people it is chronic and can become a grievous health problem for the patient and an unwelcome nighttime nuisance for family members.
Sleep Apnea is a sleep disorder known as obstructive sleep apnea or OSA. Snoring is part of this disorder, but the difference is that the patient is observed at night by their partner having long breathing pauses during sleep, which can be quite disturbing to the witness. Sleep apnea symptoms include long pauses in breathing, choking, coughing at night, chest pain, morning headaches, and difficulty concentrating.
Not all snorers have OSA, so it’s important to know the symptoms and direct the patient to the best professional help. The patient will need a formal diagnosis from a physician.
Medical devices or appliances and surgery are available that may reduce disruptive snoring. However, these aren't suitable or necessary for everyone who snores. Finding the correct mode of care takes some investigation.
In dental coding (CDT), there is a separation between snoring and sleep apnea appliances. There isn’t a specific CDT code for a snoring appliance. The code best suits this procedure is D5999- unspecified maxillofacial prosthetic, by report. A “by report code” must include a narrative and clinical notes or reports submitted with the claim.
The separate code for sleep apnea appliance is D9947-custom sleep apnea appliance fabrication and placement.
Diagnosis of obstructive sleep apnea by a physician is required to bill for an oral sleep apnea (OSA) appliance to a medical benefit plan. The diagnosis of OSA usually requires a sleep study performed by a physician.
The codes to send to a medical insurance provider for OSA appliances are:
HCPCS procedure—E0486 oral device/appliance used to reduce upper airway collapsibility adjustable or non-adjustable custom fabricated includes fitting and adjustment. Classified as DME Durable Medical Equipment, the payer sometimes requires a DME script from the dentist in order to pre-authorize (if it exceeds a certain dollar amount).
ICD-10-CMS diagnosis-G47.33 Obstructive Sleep Apnea
Some insurance payers require a patient to use a C-Pap (continuous positive airway pressure) before considering the E0486. Often the insurance payer requires the proof that the patient suffers from OSA with a sleep study and a fail/C-pap trial. Snoring is not considered a medical condition, but sleep apnea is. The overseeing physician provides a failed C-Pap affidavit and is submitted with the claim. The length of the C-Pap trial is plan specific. A dentist shouldn’t provide this appliance without documentation from the physician, even if not billing to medical insurance.
Because of the inconsistency in how the sleep apnea device is covered, it is wise to inform the patient of theirtotal responsibility in payment prior to seating the device.
Summary: Snore Guard Appliance and Sleep Apnea Appliance
Use code D5999 to report a Snore Guard Appliance with a narrative and clinical notes, and patient health history.
D5999 is the CDT code to report a Sleep Apnea Appliance, but it is not usually a dental benefit.
To bill to a medical policy, use code HCPCS E0486 and diagnostic code G47.33
Medical insurance will reimburse (if a covered benefit) if accompanied by a sleep study, DME script, and medical diagnosis from a physician.
References
https://www.mayoclinic.org/diseases-conditions/sleep-apnea/in-depth/cpap/art-20044164
https://remotesourcing.me/beware-of-new-collection-rule-when-billing/
