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Prescribing CPAP billing

Loni Posted Fri 15th of November, 2019 12:03:27 PM
Is there a code for filling out the form to prescribe a CPAP machine? This involves reviewing sleep study reports and completing the forms to send for the patient to receive the machine.
SuperCoder Answered Mon 18th of November, 2019 03:51:52 AM

Hi Loni,

There is no specific HCPCS code billed for form filling for CPAP devices. However, there are guidelines which should be met for CPAP. Please find below the details:

 

In order to support and substantiate claims for a sleep apnea device, the following documentation must be kept on file and supplied by the physician for review upon request:

 

A copy of the original physician’s (MD, DO, etc.) request, order, or referral for the sleep apnea appliance.

A copy of the physician’s documentation that sleep study was performed and results requiring an sleep appliance. This can be physician’s office visit notes; the actual sleep study report is not necessarily required.

A copy of the insurance preauthorization approval or preauthorization number is appreciated, but not required.

A copy of the appliance order.

  • The order should identify the name or description of the appliance.
  • The order should be signed and dated by the ordering provider
  • “Signature” means hand written or electronically signed by the ordering provider and dated.

 

Proof of delivery to the patient.

  • If delivery to patient’s home, a delivery ticket signed and dated by the patient/designee.
  • If provided in office setting, a confirmation of receipt form signed and dated by the patient and identifying the item/appliance. Proof of Delivery (POD) Documentation

 

Proof of delivery is needed for any tangible supply or item which is not a professional service. This includes but is not limited to: DME, supplies, self-administered drugs, home infusion therapy supplies, orthotics, etc. Proof of delivery (POD) is a Supplier Standard. Suppliers are required to maintain proof of delivery documentation in their files, and to provide the documentation upon request. “POD documentation, as well as claims documentation, must be maintained in the supplier's files for 7 years (starting from the date of service).

Proof of delivery documentation provides verification that the provider properly coded the item(s), that the item(s) delivered are the same item(s) submitted on the claim for reimbursement and that the item(s) are intended for, and received by, a specific member.

The documentation should always include:

A sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description). The long description of the HCPCS code, may be used as a means to provide a detailed description of the item being delivered.

A dated signature of the member or designee indicating receipt or delivery of the item.

For delivery directly to the patient or designee, the date of service is the date of the member’s signature for receipt.

For delivery via shipping or delivery service, the date of service is the date of shipment.

For delivery of items to a nursing facility (not using a shipping service), the date of service is

the date of the staff’s signature for receipt on behalf of the member.

 

Signature Requirements

All services provided to beneficiaries are expected to be documented in the medical records at the time they are rendered.

All medical record entries must include (among other things) the date of service, and a legible, dated, and timed signature of the provider.

Providers should not add late signatures to the medical record, other than those that result from the short delay that occurs during the transcription process.

If the signature is illegible, providers may submit a signature log or attestation to support the identity of the signer.

 

Thanks!

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