Please give opinion on husband prescribed Resmed AirCurve 10 ST

[mowork]

As I said in a post before that I do not have a copy of his sleep study. I called for copies this morning.  I did call the DME this morning and ask about prescription the doctor wrote. He wrote one for Resmed Aircurve 10 ST.  I was somewhat surprised beause he has never been on any kind of Cpap or BiPap before. I read that since he had a titration study that included both CPap and BiPap and that he failed on CPap and BiPap improved his AHI by about 90% that Medicare would let him start on a BiPap (E0470).  What I am curious about is from what I read the Resmed Aircurve ST is a E0471, which I thought Medicare requires you to use an E0470 for 3 months and prove you failed to improve before approving an E0471.  

Below, I am copying and pasting what notes were on his patient portal.  I know they are very limited.  My husband was referred to this sleep doctor by his cardiologist because of tiredness and complaining of little sleep.  His heart doctor did an Echo and stress test and ruled out heart issues before sending him for sleep study.  Any insight is appreciated. Also I am curious if there is any chance that this machine will help him? From what I read the best machine for him is the Resmed Aircurve 10 ASV.  Also do you think because the doctor said he had a backup rate of 12 breaths a mintue that is the reason he is getting the AirCurve 10 ST?  TIA

"central and obstructive sleep apnea - The patient had undergone a polysomnogram on 3/26/19 and was found to have an apnea hypopnea index 65.2. The patient did have 52% central apneas and 48% obstructive apneas. The patient did return for a CPAP/BiPAP titration study. The patient began the study on CPAP at 4 cm of water and was also studied on CPAP at 5 cm of water. There were no obstructive events but marked central events did persist. The patient was subsequently placed on BiPAP in the spontaneous mode and was studied on BiPAP and 10/5 and 11/5. No obstructive events were noted but central apneas did persist. The patient was subsequently placed on BiPAP with a backup rate at 12/5 and a backup rate of 12 breaths per minute. The apnea-hypopnea index did fall to 7.8. The patient did reach REM sleep and did have 4 obstructive hypopneas. The patient's oxygenation was adequate on the BiPAP therapy. There were no significant arrhythmias or limb movements. The entire study was reviewed in detail with patient and his wife."  I will mention that doctor stated my husband had a long time before he went to sleep and only slept 153 minutes on the titration test. Of course, this was his first experience with a Cpap or BiPap.  On the first sleep test he slept 245 min but he did not have on any device."

[jaswilliams]

Based on the titration study a BiLevel with a backup rate seems to be correct. I would suggest that an ASV would be better than the ST but unless the Dr specifically writes a prescription for it then you will only get the ST Medicare will provide what is written in your Dr’s precription

[mowork]

I think he did write the prescription for the ST.  Is the ASV the same medicare code...E4071 as the ST?  Everyone on the board seems to think that th ASV is far superior for his type of apnea.  Keep in mind he has never been on any machine.. Would Medicare even approve an ASV if the doctor ordered but he has not been on even a CPap before?

[ardenum]

It's not that everyone thinks ASV is better for his condition, its that ASV is specifically designed to treat Central Apnea.

ST is for people with respiratory insufficiency due to copd, muscle weakness and people with EF < 40%

does your husband have a heart related comorbidity?

[Sleeprider]

As Crowter infers, the only contradiction to ASV is congestive heart failure with a left ventricular ejection factor (LVEF) of less than 45%. In the absence of CHF, ASV is the ideal treatment for complex apnea that matches your husband's diagnosis. BiPAP ST only achieve an AHI of about 8 events per hour. That is not considered adequately treated by any medical criteria. If it takes a test to evaluate ASV that is on the doctor for not requesting the appropriate therapy. ASV is for complex apnea, and is the identical billing code, E0471 as compared to ST.

To prescribe ST where ASV is indicated suggests this doctor is not well-acquainted with advanced bilevel therapy options. You may need to help him catch up by providing the Resmed Titration Protocol I linked earlier. I don't want you to insult him by letting him know you are getting information from an internet forum. He will immediately reject any suggestion you tell him comes from the internet. Print the protocol and highlight the sections that show it is the right solution. It is pretty obvious what the differences are between ST and ASV, so use the manufacturer recommendations to ask your doctor to explain why he prefers ST rather than the indicated ASV for complex apnea in the absence of pulmonary disease.

[mowork]

Well he had quadrupled  ypass 3 years ago but the surgeon said there was no heart damage..and tbe recent Echo and Stress was goid but he has never had any kind of sleep appliance so he skipped CPaP and E0470 and went straight to E0471 ResMed AirCurve ST..DME said it was a Medicare issue..but if he has problems or fails to  improve then he would probably get an ASV

[jaswilliams]

Medicare should provide whatever is on the DR’s prescription. So if you get a prescription from your dr for a Resmed ASV then Medicare should supply, if the DME’s lips are moving they are lying

[Sleeprider]

The simplest solution is to discuss with the doctor whether he is willing to change the prescription to ASV. This is based on your understanding that ASV is a more appropriate therapy for the complex apnea he diagnosed. At least this lets you hear his rationale, and gives him the opportunity to rethink it. If you end up with the ST, that's fine, but you will eventually be back to asking for ASV, so you might as well understand why the doctor feels this is the best approach. The DME can only dispense what is prescribed. Bypass surgery is not a contraindication for ASV.