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 AASM Hypopnea scoring recommendation regarding scoring criteria for hypopneas included in the AHI, the AASM is aware of several payers, that still require ≥4% desaturation for hypopneas included in the AHI used for reimbursement of treatments for sleep apnea. This creates difficulties for both patients and clinicians. Click here to download and personalize a template letter to request that payers consider updating the AHI definition to the one currently recommended by the AASM.
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.