Why You Should Plan Ahead For Follow-up Sleep Study Cost

By Peter Blais, RPSGT

Looking at both the 2006 and the 2015 oral appliance clinical practice guideline, it is clear that follow-up sleep testing is recommended for patients fitted with oral appliances, says Marty R. Lipsey, DDS, MS, founder of Dental Sleep Med Systems and MedicalBillingForDentists.com.

“I have personally long been an advocate of the necessity of follow-up testing to confirm treatment efficacy of oral appliance (OA) therapy for obstructive sleep apnea (OSA),” says Lipsey, whose company offers dental teams assistance in implementing and/or improving their dental sleep medicine practices, including outsourced medical billing and successful insurance coding and processing. “While subjective reports of success from the patient are great, it is clear that the only objective method to confirm efficacy is by looking at the numbers with a follow-up study,” says Lipsey, who lectures on dental sleep medicine nationally.

The question of medical insurance paying for such a follow-up study has been raised and debated, notes Lipsey. Following are Lipsey’s thoughts on “what is and what is not likely to be paid.”

“There is no CPT code specific to a follow-up sleep study to confirm efficacy of oral appliance therapy. I have been made aware of cases where medical insurance claims have been submitted for an in-lab, post OA delivery sleep study, using the CPT code for a CPAP titration study.

“Sleep techs can certainly be trained to titrate an oral appliance during a sleep study. However, these ‘titration’ studies do not involve CPAP and this would certainly be improper use of the CPAP titration study CPT code.

“Additionally, sleep physicians have personally told me that they have been successful in getting medical insurance to pay for these types of studies, both at home and in the lab. I have not personally seen anything to corroborate this.

Lipsey

“From my point of view, it is highly unlikely that a dentist could predictably receive payment from major medical carriers for post-delivery efficacy home sleep testing. With that said, I feel that the dentist should build the cost (if any) of such a test, into the cost of the case as presented to the patient. The bottom line is that there is no other way to establish appliance efficacy.

“While I’m hoping our medical colleagues do not find this objectionable, I would propose that the dental model always include a non-diagnostic, post-delivery study, conducted by the dental team, to demonstrate efficacy of the appliance. This would allow the dentist, with the highest degree of certainty, to see that further titration of the appliance might be necessary or to advise the patient’s physician that the course of oral appliance therapy has been completed and that the patient is ready for their follow-up sleep study under the physician’s order.”