Qualifications for Home Respiratory Equipment

Qualifications for Home Respiratory Equipment What Every RT Needs To Know Paula D. Estridge, RT Objectives/Performance Measures Understand the primary components of qualifying home respiratory equipment  Identify the primary home respiratory equipment  Identify the primary insurance requirements to be met for each type of home respiratory equipment  Distinguish between the different testing required for each type of home respiratory equipment  Paula D. Estridge, RT Vocabulary      CPAP- Continuous Positive Airway Pressure Device BiPAP- Bi-level Positive Airway Pressure Device S-Spontaneous Rate Only ST-Spontaneous and Timed Rate Unit Dose Medication- Aerosolized Breathing Medications (Albuterol, Atrovent, Steriods, etc.) Oxygen- Home Oxygen Equipment including Concentrators, Liquid Oxygen Systems and Portable Gas and Liquid Oxygen Systems Restrictive Thoracic Disorders- Tuberculosis, Polio, Cystic Fibrosis, Obesity with Hypoventilation, ALS, Multiple Sclerosis, Myotonic Dystrophy, Restrictive Lung Disease, Diaphragm Paralysis, Kyphoscoliosis, Chest Wall Deformity, Spinal Cord Injury Paula D. Estridge, RT Unit Dose Medications The following diagnoses ONLY: 1. 491.0 through 505 Obstructive lung disease 2. 277.00 Cystic Fibrosis 3. 042 HIV 4. 786.4 Abnormal Sputum  The physician must have considered metered dose inhalers (MDI) prior to prescribing nebulizer treatments.  Most Common Diagnosis 1. COPD (496) 2. Emphysema (492.8) 3. Asthma (493.90) 4. Chronic Bronchitis (491.0)  Paula D. Estridge, RT Oxygen If an inpatient hospital stay, the reported test must be done no earlier than 2 days prior to hospital discharge date  If not inpatient, the reported test must be done within 30 days of the date of order while the patient is in a chronic stable state  Alternative treatment measures have been tried or considered and deemed ineffective  Paula D. Estridge, RT Oxygen Continued Group I     An ABG PO2 /= 56 mmHg or an SaO2 >/= 89% during the day while at rest. Paula D. Estridge, RT Oxygen Continued Group II Criteria include the presence of (a) a PO2 of 56-59 mmHg or an SaO2 of 89% at rest (awake), during sleep for at least 5 cumulative minutes, or during exercise (as described in Group I) and any of the following: • • • Dependent edema suggesting congestive heart failure, or Pulmonary hypertension or cor pulmonale, determined by measurement of pulmonary artery pressure, gated blood pool scan, echocardiogram, or “P” pulmonale on ECG (P wave greater than 3 mm in standard leads II, III, or AVF), or Erythrocythemia with a hematocrit greater than 56% LIMITED TO THREE MONTHS OR THE PHYSICIAN SPECIFIED LENGTH OF NEED, WHICHEVER IS SHORTER THEN NEW TESTING WILL BE REQUIRED TO CONTINUE COVERAGE. Paula D. Estridge, RT OXYGEN TESTING TIPS     DO RESTING, ON ROOM AIR PO2 OR SaO2 FIRST (/= 45 mmHg, or B: Sleep oximetry documents SaO2 /= 52 mmHg, and 2. Sleep oximetry documents SaO2 /= 52 mmHg, and Sleep oximetry, repeated no sooner than 61 days from the start of therapy on the BiPAP S, while breathing on the BiPAP S, documents SaO2