What’s Next?
Steps to take for Common situations
1.) If you THINK you have a problem with Sleep Apnea:
- Call for a FREE consultation appointment with Dr Mallia.
- She will do a screening questionnaire, review risk factors and answer questions.
- If Dr Mallia is concerned about your breathing problem while sleeping, she will assist you in getting a sleep study. Dr Mallia does not order a sleep study, but she can refer you to a sleep specialist to get this test ordered.
- Once a study is completed .
2) Once a study is completed and you have a DIAGNOSIS of Obstructive Sleep Apnea: (Oral Appliance Therapy is not for treating Central Sleep Apnea)
- Call for a FREE consultation appointment with Dr Mallia.
- She will review the sleep study and the physician’s diagnosis, perform an oral evaluation to determine if you are a candidate for oral appliance therapy (OAT) and answer questions.
- Forms you need to bring – medical insurance card, physician’s notes before the sleep study, copy of sleep study less than a year old, sleep physician’s notes and diagnosis, a prescription form for a sleep appliance, dental x-rays that are less than a year old.
3) If you have a CPAP device and want to have an alternative treatment:
- Call for a FREE consultation appointment with Dr Mallia.
- Forms you need to bring – medical ins card, physician’s notes before the sleep study, copy of sleep study less than a year old, sleep physician’s notes and diagnosis, a prescription form for a sleep appliance, dental x-rays that are less than a year old.
- If your insurance company is paying for your CPAP therapy such as CPAP unit & replacement parts, they most likely will not pay for another therapy unless there is physician documentation of a medical need to change therapies.
- If you want a “travel therapy” and don’t want to go through medical insurance to cover an oral device, ask Dr Mallia about a cash option discount.
Documentation Needed for a Referral to Design 4 Sleep
1) Face-to-face physician’s consultation note before the sleep study stating why the sleep study was ordered. EX: “Sleep study ordered due to snoring.”
WITH any diagnosis code that applies, example: HTN, snoring, A-Fib, etc.
2) A signed order for a home sleep test IF the current sleep study is over 1 year old.
3) The actual sleep study report AND the sleep study interpretation.
- Documentation of at least one comorbidity IF AHI/RDI is 5-14 with a minimum of 10 events (excessive daytime sleepiness can only count as a comorbidity IF the Epworth is 11 or more)
- Documentation of CPAP intolerance and why IF AHI/RDI is greater than 30 OR the physician determines the use of a PAP device is contraindicated.
4) Insurance requires results visit be with the ordering physician and the only diagnosis code insurance will cover is - Obstructive Sleep Apnea – ICD10 Code G47.33.
- UHC and UMR require the consult visit to order the HST and the results visit to be with a board-certified sleep doctor.
5) Design 4 Sleep’s Prescription Form, for Oral Appliance Therapy, filled out and signed by the referring care provider.
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