Health Information Management

Tip: Document medical necessity for sleep tests

APCs Insider, June 5, 2009

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In March, CMS issued a decision memo broadening coverage of sleep testing for obstructive sleep apnea (OSA). However, facilities must make sure they can justify conducting a sleep study.
Facilities must ensure physicians use other tests to establish an OSA diagnosis before ordering a sleep study and don’t just put OSA at the top of the list of possible diagnoses for any patient meeting the indications (e.g., a short patient with a high body mass index and a receding jaw).
Facilities should:
  • Read the decision memorandum and any subsequent national and local coverage determinations thoroughly and carefully. 
  • Insist on appropriate documentation and not accept physician orders for OSA at face value.
This tip was adapted from the article “Strong documentation puts OSA coverage trouble to sleep” from the June issue of Briefings on APCs.

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