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For other articles and previous issues click here. October 4, 2004 Coding
for Sleep Apnea If a person regularly stops breathing for 10 seconds or longer during sleep, he or she may have a condition called sleep apnea. Apnea is a Greek word that literally means “without breath.” Sleep apnea may be classified as mild, moderate, or severe and is determined by the number of times per hour that the person stops breathing or breathing is slowed (hypopnea). Mild sleep apnea may be diagnosed when breathing stops five or less times per hour. Severe sleep apnea is when the breathing stops as much as 50 times per hour. Types of Sleep Apnea • Obstructive sleep apnea is usually caused by blockage (obstruction) in the nose, mouth, or throat. When the muscles that support the soft palate, uvula, tonsils, and tongue relax, the airway is narrowed or closed as the person breaths in and the breathing is temporarily cut off. This lowers the oxygen level in the blood. When breathing stops, the person may make grunting, gasping, or snorting sounds and restless body movements. The brain then rouses the patient from sleep and reopens the airway. Because the patient is frequently awakened to open the airway, the patient is unable to reach deep sleep. • Central sleep apnea occurs when the brain fails to signal the muscles to breathe, which increases the carbon dioxide level and decreases the oxygen level in the blood. • Mixed sleep apnea is a combination of the
above types. Signs and Symptoms • Excessive daytime sleepiness (hypersomnia) • Loud snoring/disruptive snoring • Observed episodes of breathing cessation during sleep • Abrupt awakenings with shortness of breath • Awakening with a dry mouth or sore throat • Morning headache • Feeling irritated • Falling asleep at inappropriate times such as while eating, driving, or talking • Tossing and turning during sleep/restless sleep • Feeling suffocated during sleep • Night time choking spells, sweating, and chest pain • Heartburn at night Diagnosis • Nocturnal polysomnography (sleep study) measures the activity of the body during sleep by monitoring heart, lung, brain activity, breathing patterns, arm and leg movements, and blood oxygen levels. • Oximetry monitors the blood oxygen levels while the patient sleeps at home. The patient is connected to a machine by a device on the finger. • Sleep videotape shows behavior such as restless movements, choking, or gasping. • Electroencephalogram monitors the brain waves and can reveal repeated awakenings. • Multiple sleep latency test measures the speed of falling asleep in the daytime to determine the degree of excessive daytime sleepiness. • Referral to otolaryngologist to rule out blockage in nose or throat. • Referral to cardiologist or neurologist to look for cause of central sleep apnea. Treatment • Uvulopalatopharyngoplasty (UPPP) removes tissue from the back of mouth and top of throat. UPPP is classified to codes 27.69 and 29.4. • Tonsillectomy and adenoidectomy are done if tonsils and adenoids are blocking the airway. Tonsillectomy is classified to code 28.2. Adenoidectomy is assigned to code 28.6. If both procedures are done together, assign code 28.3. • Laser-assisted uvulopalatoplasty may be performed in the physician’s office. It uses a laser to remove part of the soft palate and shortens the uvula to eliminate snoring. Assign code 27.69 for this procedure. • Radiofrequency ablation may be performed in the physician’s office. It uses radiofrequency energy to remove tissue from the uvula, soft palate, and tongue • Tracheostomy (31.29) creates an opening in the throat below the blockage. The opening is kept covered during the day but opened at night to allow air to pass in and out. • Nasal surgery to remove polyps (21.31) or repair a deviated nasal septum (21.88). • Surgery to move the jaw, facial bones, and
tongue forward. • Treatment of associated medical problems • Supplemental oxygen • CPAP • Bi-level positive airway pressure (bi-level PAP) Coding and sequencing for sleep apnea are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, and Vicki Sippel, RHIA, of 3M Health Information Systems (800-367-2447), a leading supplier of coding and classification systems to nearly 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
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