Take Action
The AASM encourages members to participate in ongoing advocacy efforts, as much as possible, to add the voices of sleep facilities and providers. Review the current list of template letters, created for communication with payers and other stakeholders, as appropriate.
Align with the AASM Recommended Hypopnea Scoring Criteria
While many payers have adopted the recommended AASM scoring criteria for hypopneas (≥3% oxygen desaturation and/or arousal), the AASM is aware of several private payers, that still require that AHI be calculated using ≥4% oxygen desaturation for hypopneas in order to be reimbursed for treatments for sleep apnea. Click here to download and personalize a template letter to request that private payers consider updating the AHI definition to the one currently recommended by the AASM. As AASM continues to advocate for policies to be updated, members that treat patients whose payers require the ≥4% desaturation for hypopneas (e.g., Medicare) are encouraged to score using both criteria.
Coverage of Appropriate Treatment for Insomnia
Many private payers have established medical policies and coverage guidelines for the treatment of insomnia. However, many of these policies were developed prior to the publication of the Behavioral and Psychological Treatments for Chronic Insomnia Disorder in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline, and are, therefore, not closely aligned with the guideline recommendations. Click here to urge private payers to review current insomnia treatment policies and make any necessary modifications to align their policies with the recently published AASM guideline, to support the practice of evidence-based medicine in adult patients with insomnia.
Appropriate coding for Treatment-Emergent Central Sleep Apnea
Electronic health record (EHR) vendors and payers are requiring an incorrect diagnosis code, G47.31, Primary Central Sleep Apnea, for Treatment-Emergent Central Sleep Apnea. Per the 3rd edition of the AASM International Classification of Sleep Disorders (ICSD-3), the appropriate diagnosis code is G47.39, Other sleep apnea. The use of this code is problematic for two reasons: First, sleep medicine physicians are compelled to choose a diagnostic code that is inconsistent for a specific diagnosis, to get the service documented and reimbursed. Secondly, EHR system requirements are set based on the preferences for each facility/practice. Click here to download and personalize the attached template letter to request the code be updated by your EHR vendor and/or payers.