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.
Prescription for Oral Appliance Therapy for Obstructive Sleep Apnea (OSA)
Online Form
Download Form
Online Form
Downlaod Form