Out of Center Sleep Testing (OCST)
1. Out of center sleep tests are covered for the evaluation of obstructive sleep apnea (OSA) or snoring when the out of center sleep testing is used as part of a comprehensive sleep evaluation, there is high pre-test probability of sleep apnea (STOP-BANG score ≥6) and the following criteria requiring attended PSG are not met.
a. at least one of the following comorbid medical conditions that degrade the accuracy of portable monitoring:
  • Moderate to severe pulmonary disease (with p02 less than 60 or pCO2 greater than 45 or patient on nocturnal oxygen or FEV1 pred <70% or pulmonary hypertension or secondary polycythemia, etc.)
  • Neuromuscular disease (e.g., Parkinson's disease, spina bifida, myotonic dystrophy, amyotrophic lateral sclerosis, kyphoscoliosis)
  • History of stroke
  • Epilepsy
  • Congestive heart failure (NYHA class III or IV or LVEF less than 45%)
  • Cardiac arrhythmia (e.g., Atrial fibrillation, ventricular arrhythmia)
  • Morbid obesity (BMI greater than 45)
  • Cognitive impairment that impacts ability to use portable monitoring equipment safely and effectively at home
b. one or more of the following comorbid sleep disorders:
  • Periodic limb movement disorder
  • Parasomnias
  • Moderate to severe insomnia with self-reported sleep efficiency less than or equal to 70%
  • Narcolepsy
  • Central sleep apnea or complex sleep apnea
  • Chronic narcotic use as this increases central sleep apneas
c. less than 18 years of age
e. lacks the mobility or dexterity to use portable monitoring equipment safely and effectively at home
f. Member is a commercial driver or airline pilot, or there is a regulatory agency, employer or third-party requirement for attended lab PSG
g. does not have a high pre-test probability of sleep apnea (STOP-BANG score <6)

2. Must be ordered by a Board Certified Sleep Medicine Physician.

3. Must be interpreted by a Board Certified Sleep Medicine Physician.

4. OCST must be performed at or under the direction of an American Academy of Sleep Medicine (AASM) accredited sleep disorders center or OCST facility.

5. An experienced sleep technician, sleep technologist, or appropriately trained healthcare practitioner must perform the application of OCST sensors or directly educate the patient in the correct application of sensors.

8. The testing must include parameters consistent with the American Academy of Sleep Medicine Standards of Practice and Clinical Guidelines, using technology and sensors consistent with the American Academy of Sleep Medicine Technology Evaluation.

9. OCST with invalid results due to sensor failure, and results that fail to establish the diagnosis of OSA (apnea-hypopnea index >5), must be followed by an attended lab PSG.


Note:
1. Out of center sleep testing is a reasonable option, using equipment with certain kinds of sensors for patients with high pre-test probability (80%) for obstructive sleep apnea (Obstructive Sleep Apnea Devices for Out-of-Center (OOC) Testing: Technology Evaluation, Collop et al, JCSM Vol 7, No. 5, 2011; 80% pre-test probability occurs at a STOP-BANG score of 6, High STOP-BANG score indicates a high probability of obstructive sleep apnoea, Chung et al, British Journal of Anaesthesia Vol 108, No. 5, 2012). Specifically, the Technology Evaluation found that

a. Thermal sensing device without effort measure (Apnoeascreen I) was not adequate to diagnose OSA

b. Thermal sensing device with effort measure (2 piezo-electric belts or 2 RIP belts) and oximetry was adequate to diagnose OSA (Apnoeascreen II and Somte Morpheus were adequate but PS-2 was not) (CPT code 95806)

c. Nasal pressure with oximetry but without effort measure was adequate to diagnose OSA (ApneaLink and ARES) (CPT code 95801)

d. Nasal pressure with effort measure (2 RIP belts or 2 piezo belts but not 1 piezo belt) and oximetry was adequate to diagnose OSA (Embletta was adequate, Stardust II was not)

e. Watch PAT was adequate to diagnose OSA (CPT code 95801)

f. Cardiac and oximetry signals showed promise but more research is required

g. etCO2 with effort and oximetry (Morpheus Hx) may be adequate but more research is required

h. Acoustic signal analysis instead of airflow was not adequate to diagnose OSA (Novasom QSG, SNAP, Remmers, ARES)

2.    It would be required that the AASM standard of practice (3.2 in Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adult Patients, JCSM Vol 3, No. 7, 2007,) recommendation that “an experienced sleep technician, sleep technologist, or appropriately trained healthcare practitioner must perform the application of PM sensors or directly educate the patient in the correct application of sensors” be followed. Such education would be performed face-to-face, not by video, website, or telephone.

MASM | 3031 West Grand Blvd, Suite #645, Detroit, MI 48202 | Phone: (313) 874-1360, ext 303 | Fax: (313) 874-1366 | Email: kcarter@wcmssm.org

Copyright 2014: MASM, All Rights Protected

 

Powered by Wild Apricot Membership Software