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CPT/HCPCS REFERENCE CODES

PRODUCT REFERENCE GUIDE

BEDSIDE COMMODES


  • Bedside commodes are only covered if the patient is room-confined or unable to get t0 toilet facilities. Commodes re not covered if they are placed over the toilet facilities. Commodes are not covered if they are placed over the toilet in the bathroom. Medical need must be documented in patient's medical record.
  • Heavy duty commodes: width equal to or greater than 23 inches and a weight capacity 300 pounds or more.
  • Detachable arms are covered when used to facilitate transfers or if the patient has a body configuration the requires extra width. This applies to any commode.
  • Supplier must have documentation on file detailing why patient is room-confined or unable to access toilet facilities.

BEDSIDE COMMODES


  • Bedside commodes are only covered if the patient is room-confined or unable to get t0 toilet facilities. Commodes re not covered if they are placed over the toilet facilities. Commodes are not covered if they are placed over the toilet in the bathroom. Medical need must be documented in patient's medical record.
  • Heavy duty commodes: width equal to or greater than 23 inches and a weight capacity 300 pounds or more.
  • Detachable arms are covered when used to facilitate transfers or if the patient has a body configuration the requires extra width. This applies to any commode.
  • Supplier must have documentation on file detailing why patient is room-confined or unable to access toilet facilities.

PATIENT LIFTS


  • Patient lifts (hoyer or other types) are covered if transfer between bed and a chair ,a wheel chair or commode requires the assistance of more than one person and without the use of a lift,the patient would be bed confined.

LIFT CHAIRS


All of the following criteria must be met in order to consider coverage:

  • Patient must be able to ambulance once standing (cannot be used in conjuction with a wheelchair or POV).
  • Has severe arthritis of hip or knee or severe neuromuscular disease. Diagnosis required.
  • Must be a part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration of the patient's condition.
  • Patient must be completely incapable of standing up from any chair, particularly a low chair, is not sufficient justification for a seat-list mechanism. Almost all patients who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.
  • Once standing, the patient must have the ability to ambulance

SUPPORT SURFACES


GROUP1 (OVERLAYS)

Group 2 (pressure reducing)

Group 3(air-fluidized bed)


GROUP1 (OVERLAYS)(mostly overlays) patient must meet criteria 1,2 or 3.

1.completely immobile - Patient must cannot make changes in body position without assistance, OR

2. limited mobility- Patient cannot independently make changes in body position significant enough to alleviate pressure OR

3. Any stage pressure ulcer on the trunk or pelvis.


If the patient meets criteria 2 or 3 above he/she must also have at least one of the following conditions:

A. Impaired nutritional status

B.Fecal or urinary incontinence

C. Altered sensory perception

D. Compromised circulatory status


GROUP 2 (powered pressure-reducing mattresses).

Patient must meet criteria 1 AND 2 OR criterion 3 OR criterion 4 OR criterion below,

1. Multiple stage II pressure ulcers located on trunk or pelvis that have failed to improve over the last month AND

2. Patient has been on a comprehensive ulcer treatment program for at least the past month, which has included: the use of an appropriate Group I support surface; regular assessment; appropriate Group I support surface; regular assessment ; appropriate tuning positioning and wound care; moisture and incontinence management ; and nutritional assessment and intervention.

3. Large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis.

4. Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days) and patient has been on a Group 2 or 3 support surface immediately prior to discharge from the hospital or nursing facility (discharge within the past 30 days).


GROUP 3 (air fluidized bed) Patient must meet ALL of the following.

1. Stage-III (full thickness tissue loss) or stage IV (deep tissue destruction ) pressure sore.

2.Bedridden or chair bound as a result of severely limited mobility.

3. In absence of an air-fluidized bed, the patient would require institutionalization.

4.The air-fluidized bed is ordered in writing be the patient's attending physician based upon a comprehensive assessment and evaluation of the patient after conservative treatment has been tried without success. Conservative treatment should generally include frequent repositioning; use of Group2; would management; nutritional optimization; education of patient and caregiver on the prevention and / or management of pressure ulcers and ; assessment by physician , nurse or other licensed health care practitioner at least weekly.

BEDS


Coverage is considered for a fixed-height hospital bed when at least one of the following are met:

  • Has a medical condition which requires positioning of the body in ways not feasible with an ordinary bed.
  • Patient requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain.
  • Requires the head of the bed to be elevated more than 30 degrees most of the time because of CHF, COPD or problems with aspiration.
  • Requires traction equipment that can only be attached to a hospital bed.

In a heavy duty-type bed is medically necessary, the weight must be at least 350pounds and must be documented. Medicare does not cover full electric beds, Smi-electric beds are considered for coverage if one of the above criteria is met AND If the patient requires frequent changes in body position such as to alleviate paint, prevent aspiration or respiratory issue.


MOBILITY EQUIPMENT


What are the rules? Remember you must rule out each lower level item. Medicare pays for the least costly altenative.


ITEM REQUIRED


1. Cane - written order and there is a mobility impairment but potential for ambulation.

2. Walker - Written order and there is mobility impairment that cannot be corrected with a cane but potential for ambulation. Heavy duty would need weight greater than 300 pounds.

3.Specialty walker (HD - multiple braking system ,variable wheel resistance walker) - patient meets criteria for a walker but cannot use standard due to severe nerologic disorder or other condition causing restricted use of one hand (obesity alone is not sufficient reason).

4.Manual wheelchairs- Must rule out of cane/ walker

a. standard-Rule out cane and walker ; does not have to be able to self-propel, but needs manual wheelchair for use within the home.

b.Hemi-height - Needs manual wheelchair; needs lower seat to floor height for transfers and/ or to assist with self-propelling with feet.

c. Lightweight - Rule out cane/walker and standard weight manual wheelchair .MUST be independent in self-propelling with the lightweight wheelchair (cannot be needed solely for caregiver convenience).

d. High strength lightweight - Rule out standard, hemi-height and lightweight. Needs a seat width/seat depth/seat-to-floor height not available in ANY lower level base and/ or patient is up in chair greater than two hours per day and highly active. Does not have to be self-propeller. Needs could relate to activity level or size of patient (i.e., extremely tall or very short and requires ultra-hemi seat height).

e. Ultra lightweight - As of march 1, 2013, requires ATP and PT/OT evaluation as well as face-to-face exam by physician and must have past history of use of same type base and activity both inside and outside home. Patient must be a full-time independent manual wheelchair user and must require individualized fitting and adjustments such as, but not limited to ,axle configuration, wheel chamber or seat and back angles that are not available on a lower-level wheelchair. Need to be very specific as to what is needed on this base that is not available on a high-strength lightweight base(K0004).

f. Heavy-duty base is covered if patient needs a manual wheelchair and weight is greater than 250pounds.

g. Extra heavy duty is covered if patient needs a manual wheelchair and weight is greater than 300pounds.

h. A transport chair ( E1037, E1038 or E1039) is covered in lieu of a standard manual wheelchair for use within the home.


With all manual wheelchairs , the first rule to remember is that the need is for IN THE HOME and must rule out each lower - level item before a higher level is covered.

POWER WHEELCHAIR


Coverage Criteria for K0010, K0011,K0012

  • An individual who requires a power wheelchair is usually totally non-ambulatory and has severe weakness of the upper extremities that prevents them from self-propelling in a manual wheelchair. Medicine has certain coverage criteria to qualify a patient medically for a K0010, K0011,K0012. A Power Chair could be considered medically necessary when all of the following coverage criteria are met:
  • The patient's condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined ; and,
  • The patient's condition is such that a wheelchair is medically necessary and the patient is unable to operate a wheelchair manually; and( Q7 on CMN=Y).
  • The patient is capable of safely operating the controls for the power wheel-chair.
  • The patient requires the use of a wheelchair to move around in their residence(Q1 on CMN=Y).
  • The patient has severe weakness of the upper extremities due to a neurological , muscular , or cardiopulmonary disease or condition(Q6 on CMN=Y).

Coverage Criteria for K0014

  • The beneficiary must first meet the coverage criteria for a K0010/K0011/K0012 and;
  • There must be supporting documentation as to why one of these power chairs(K0010/K0011/K0012) will not accommodate the patient's medical needs.
  • A K0014 (other motorized/power wheelchair base ) is covered only if the feature needed is not available as an option in an already manufactured base (K0010/K0011/K0012).

OXYGEN AND OXYGEN EQUIPMENT


The key is to make sure there is documentation in the medical record indicating need for home oxygen therapy.

GROUP 1

1. Patient has a severe lung disease or hypoxia-related symptom that might improve therapy.

Examples:

  • COPD, diffuse interstitial lung disease, bronchiectasis, cystic fibrosis
  • Hypoxia related symptoms such as pulmonary hypertension, recurring CHF due to chronic cor pulmonale, erythrocytosis, impairment of congnitive process, nocturnal restlessness and morning headache.
  • Hypoxemia alone will not be covered. There need to be an underlying condition causing the hypoxemia.
  • Non-covered conditions: angina pectoris in absence of hypoxemia, breathlessness without cor pulmonate or hypoxemia, severe peripheral vascular disease, terminal illnesses that do not effect lungs, pneumonia.

2. Blood gas study meets criteria indicated below:

  • Method1 : On room air at rest while awake, oxygen saturation equal to or less than 88percent or ABG equal to or less than= 55mm Hg
  • Method2 : If during exercise must have the following three tests documented:
  • 1. Oxygen saturation on room air at rest- (should be above 88 percent)
  • 2. Oxygen saturation on room air with exercise - needs to be equal to or less than 88 percent
  • 3. Oxygen saturation on oxygen with exercise - shows improvement with oxygen
  • NOTE: If patient qualifies with method2, then WHOMEVER does the testing must document and provide all three test results of the above test results; otherwise the oxygen will not be covered.
  • Method3 : During sleep in room air equal to or less than 88 percent for at least 5minutes and does not have to be continuous.

3.Alternative treatment measures, such as inhalers or nebulizer treatments, have been tried or considered, and ruled out or clinically ineffective.


For Group I, all three items listed above need to be met AND evidence of an in-person visit with treating practitioner that was done during office visit or as inpatient in a hospital setting must exist. The visit must have occurred within 30days prior to initial setup.


GROUP 2

1. Dependent edema suggesting CHF, OR

2. Pulmonary HTN or car pulmonale determined by measurement of pulmonary artery pressure, echocardiogram, or "P" pulmonale on EKG ,OR

3. Erthrocythemia with haematocrit greater than 56 percent , OR

4.ABG with PO2 of 56-59mm Hg or oxygen saturation of 89 percent at rest, while awake, during sleep for five minutes or during exercise as described under Group 1


Blood gas study :

1. Study must have been performed within 30days of initial setup, or during an impatient hospital stay and test done within two days prior to discharge date.

2. Performed while patient was in chronic stable state. Not during an acute illness or exacerbation of an underlying lung disease or in emergency room situation.

3. Blood gas study must have been performed by a physician or qualified provider or laboratory services that can bill Medicare such as an IDTE.

Helpful notes:

  • If portable oxygen is being ordered, there needs to be documentation in the medical records indicating the patient is mobile within the home.
  • Portable oxygen is considered when the blood gas study is performed while patient is awake or with exercise. At-night use only does not qualify for a portable unit.
  • A frequent of use must be indicated , i.e. 2 Ipm or continuous or 3lpm at night, PRN, or as needed basis, is not covered by Medicare.
  • DMEPOS suppliers are not considered as qualified to perform blood gas studies.
  • If patient is under a part A covered stay payment such as hospital, nursing facility, home health or hospice meets the qualified provider standard. Need to be sure that patient is under a Part A covered payment ; if not , them the requirements are not met and qualification would be invalid.

Detailed Written order (DWO) must contain the following:

1.Benificiary's name

2. Date of order and start date, if different from date of order

3. Detailed description of the item being ordered

4. Route of administration

5. Frequency of use

6. Length of need

7. Treating practitioner's printed name and NPI

8. Treating practitioner's signature and date


  • The CMN can be the DWO but must contain all the information listed above.
  • In most cases , the detailed written order and medical record documentation must be obtained prior to delivery of the oxygen equipment.

Obstructive sleep apnea with use of home oxygen therapy:

For patients requiring the use of home oxygen with PAP device, both the PAP and oxygen policies must be met. The qualifying blood gas study must be performed during a titration study at a sleep lab facility making sure the pressure is at an optimal setting. The oximetry study performed during this titration shows oxygen saturation of 88 percent or less for five total minutes(does not have to be continuous) . There has to be a reduction in AHI/RDI reduced to less than or equal to an average of 10 events/hours or if the initial AHI/RDI was less than an average of 10 events per hour, then the titration demonstrates further reduction in AHI/RDI.


Recertification:

The following to be obtained with the recent CMN for either Group 1 or Group 2:

1. Re-evaluation by treating physician documenting patient is benefiting from the oxygen therapy and has shown improvement

2. Copy of most recent blood gas study (can be from the initial test, if that is the most recent) BUT should not be the normal practice.


GROUP 1 = Required after 12months of initial certification, which means the re-evaluation must occur within 90days prior to the date of recertification.

GROUP2 = Required after 12months of initial certification , which means the re-evaluation must occur between the 61st-90th day following the initial date.

RESPIRATORY ASSIST DEVICES (RAD)


There are four different clinical groups characterized as :

GROUP I : Restrictive Thoracic Disorders

GROUP 2: Severe Chronic Obstructive Pulmonary Disease (COPD)

GROUP 3: Central Sleep Apnea (CSA) or Complex Sleep Apnea(Comp SA)

GROUP 4: Hypoventilation Syndrome


FOR INITIAL COVERAGE:

GROUP 1 : Restrictive Thoracic Disorders

1. Neuromuscular disease or severe thoracic cage abnormally AND

2.One of the following

a. Arterial blood gas PaCO2, while awake and breathing patient’s prescribed F102 is greater than 45mm Hg, OR

b. Sleep oximetry demonstrates oxygen saturation less than 88 percent for more than 5minutes nocturnal, while breathing prescribed F102, OR

c. For neuromuscular disease (only)

i. maximal inspiratory pressure less than 60cm H2O OR

ii. Forced vital capacity less than 50 percent predicted

3. COPD does not contribute significantly to patient’s pulmonary function.


GROUP II: Severe COPD

Standard BiPAP without backup (E0470):

1. ABG PaCO2, while awake and breathing patient’s prescribed FiO2 greater than 52mm Hg ; AND

2. Sleep oximetry demonstrates oxygen saturation of less than or equal to 88 percent for at least 5minutes nocturnal , done while breathing 2lpm or the patient’s prescribed FiO2 (whichever is higher); AND

3. Prior to initiating therapy, OSA and treatment with CPAP has been considered and ruled out.


BIPAP with backup(E047 I):

Covered for COPD in following two situations:

Situation I- BiPAP with backup started any time after a period of initial use of BiPAP without backup if both A and B are met:

A. ABG PaCO2, while awake and breathing beneficiary’s prescribed FiCO2, shows that the beneficiary’s PaCO2 worsens greater than or equal to 7mm Hg compared to original result from #1 above.

B. Facility-based PSG demonstrates oxygen saturation less than or equal to 88 percent for at least five minutes nocturnal (minimum recording 2hours) while using BiPAP without backup that is not caused by obstructive upper airway event.


Situation 2- BiPAP with backup no sooner than 61days after initial issue of BiPAP without backup if both A and B met:

A. ABG PaCO2 done while awake and breathing beneficiary’s prescribed FiO2, still remains greater than or equal to 52mm Hg AND

B. Sleep oximetry , while breathing with BiPAP without backup, demonstrates oxygen saturation less than or equal to 88percent for at least five minutes nocturnal, (minimum recording time of two hours) while breathing oxygen at 2lpm or prescribed FiO2 , whichever is higher.


GROUP III : Central Sleep Apnea or Complex Sleep Apnea

Prior to initiating therapy, a polysomnogram must be performed documenting both A and B

A. Diagnosis of central sleep apnea (CSA) or complex sleep apnea (CompSA),AND

B. Significant improvement of the sleep-associated hypoventilation with the BiPAP with or without backup.

Central Sleep Apnea(CSA) Is defined as:

1. An apnea-hypopnea index (AHI) greater than or equal to five, AND (changed 6/1/2013)

2. Central apneas/hypopneas greater than 50 percent of the total apneas/hypopneas, AND

3. Central apneas or hypopneas at minimum of five times per hour, AND

4. Symptoms of either excessive sleepiness or disrupted sleep (Hypopneas can be either central or obstructive ; does not need to be defined)


GROUP IV : Hypoventilation Syndrome

BiPAP without backup covered if 1,2,and either 3 or 4

1. ABG PaCO2, done while awake breathing prescribed FiO2 is greater than or equal to 45mm Hg.

2. Spirometry shows FEVI/FCV greater than or equal to 70percent and FEVI greater than 50 percent of predicted.

3. ABG PaCO2, done during sleep or immediately upon awaking breathing prescribed FiO2 shows the beneficiary’s PaCO2 worsened greater than or equal to 7mm Hg compared to result in criterion 1 above

4. PSG demonstrates oxygen saturation less than or equal to 88percent for at least 5minutes nocturnal (minimum recording time of two hours ) not caused by obstructive upper airway events.


BIPAP with backup covered if 1,2 and either 3 or 4

1. BiPAP without backup is being used.

2. Spirometry shows FEVI/FVC greater than or equal to 70 percent and FEVI greater than or equal to 50 percent of predicted.

3. ABG PaCO2 done while awake breathing prescribed FiO2 shows beneficiary’s PaCO2 worsens greater than or equal to 7mm Hg compared to ABG performed to qualify for BIPAP without backup.

4. PSG demonstrates oxygen saturation less than or equal to 88percent for at least 5minutes nocturnal (minimum recording time of 2hours) that is not caused by obstructive upper airway events.


Detailed Written Order Requirements:

  • Beneficiary’s name
  • Date of order, and start date if different
  • Detailed description of item(s) being ordered such as device, humidity, type of mask , headgear, filters or tubing
  • Pressure settings
  • Frequency of use of duration
  • Treating practitioner’s printed name and NPI
  • Treating practitioner’s signature and date

Continued Coverage beyond the first three months:

Must be re-evaluated by treating practitioner no sooner than 61st day after initial therapy.

  • Documenting that patient is compliant with the device. Compliance is using the machine for at least four hours per a 24-hour period.
  • Documentation that patient is benefiting from use of the therapy.
  • Make sure it’s signed and dated by treating practitioner.

POSITIVE AIRWAY PRESSURE DEVICES (PAP)


For Positive Airway Pressure or BiPAP without backup –the only diagnosis that is covered is obstructive sleep apnea (OSA), 372.23.

For initial coverage , all three of the following have been met:

1. Evidence of a face-to-face evaluation by the treating practitioner prior to the sleep test to assess the patient for OSA.

2. Sleep test that meets the following:

a. The AHI or RDI is greater than or equal to 15 events per hour with minimum of 30events, OR

b. The AHI or RDI is greater than or equal to 5 and less than 4 events per hour with a minimum of I 0 events and documentation of:

i. Excessive daytime sleepiness, impaired cognition, mood disorders, insomnia OR

ii. Hypertension , ischemic heart disease or history of stroke

3. The patient and/or caregiver has received instruction from supplier on the proper use and care of the equipment.


Detailed Written Order requirements:

  • Beneficiary’s name
  • Date of order, and start date if different
  • Detailed description of item(s) being ordered such as device, humidity, type of mask , headgear, filters or tubing
  • Pressure settings
  • Frequency of use of duration
  • Treating practitioner’s printed name and NPI
  • Treating practitioner’s signature and date

Continued coverage beyond the first three months:

Between 3I and 9I days of therapy, the following must occur:

1. Face-to-face clinical re-evaluation with treating practitioner documenting that symptoms of OSA are improved and the patient is benefiting from therapy.

2. Objective evidence of adherence to therapy, reviewed by the treating practitioner. Adherence to therapy is using the PAP at a minimum of 4hours per night on 70 percent of nights during a consecutive 30-day period anytime during the trial period.


If patient fails to initial three-month trial period , then they need to re-qualify for a PAP device and then follow the initial coverage criteria.


If PAP device is tried and found ineffective, whether it’s during the facility testing or in the home, substitution of a BiPAP without backup may occur according to the following:

  • If more than 30days remaining in trial period , the length of the trail period does not change
  • If less than 30days remaining in trial period, the length of the trial the clinical re-evaluation and adherence to therapy must occur before the 120th day.
  • If PAP device was used more than 3months , then switched, the clinical re-evaluation must occur between 31st-91st day following the initiation of BiPAP without backup.

Concurrent use of oxygen with PAP therapy

If a patient requires simultaneous use of home oxygen therapy and a PAP device , documentation by the treating practitioner in the medical record must clearly demonstrate that the requirements for coverage outlined in both the PAP and Oxygen policy have been met. Refer to the oxygen section for coverage criteria of home oxygen therapy.

NON-INVASIVE VENTILATORS


Non-invasive ventilator treatment is generally covered if treatment is needed for:

  • Neuromuscular disorder
  • Thoracic disorder disease
  • Chronic respiratory failure associated with a respiratory illness such as chronic obstructive pulmonary disease (COPD)

If patient has had repeated hospital admissions due to respiratory failure, make sure that this information is documented because it will help meet coverage. If a ventilator is used, make sure follow-up visits are documented to show there was a decrease in admissions. Remember to show there was a decrease in admissions. Remember Medicare pays for least costly alternative, which means a BIPAP or BIPAP S/T needs to be considered and/ or ruled out. Clinical documentation must be specific to the individual patient’s needs.

Descriptors can be the fact that the only other alternative would be a tracheostomy which would increase chances of infections and adds increased trauma to an already stressed patient and his / her family.

Monthly rental payments include the payment for supplies and accessories.

SMALL VOLUME NEBULIZER MACHINES


Nebulizers are covered only in the following situations indicated below by the charts , the medical record needs documentation to support the medical necessity to administer one of the following inhalation drugs for one of the listed conditions:

Other Types of Nebulizers

Ultrasonic Nebulizer (E0574) with Treprostinil (J7686) or Controlled Dose Inhalation Drug Delivery System(K0730) and IIoprost(Q4074), the following criteria needs to be met :

1. Patient has diagnosis of pulmonary artery hypertension(416.0 or 416.8), AND

2. Pulmonary hypertension is not secondary to pulmonary venous hypertension or disorders of the repository system, AND

3. Patient has primary pulmonary hypertension or pulmonary hypertension which is secondary to one of the following conditions:

  • Connective tissue disease, OR
  • Thromboembolic disease of the pulmonary arteries, OR
  • HIV infection, OR
  • Cirrhosis, OR
  • Anorexigens (diet drugs), OR
  • Congenital left to right shuns, etc , AND

a) If one of the above conditions is present , the following criteria must also be met:

i. Pulmonary hypertension has progressed despite maximal medical and / or surgical treatment of the identified condition, AND

ii. Mean pulmonary artery pressure is greater than 25mm Hg at rest or greater than 30mm Hg with exertion, AND

iii. Patient has significant symptoms from the pulmonary hypertension (such as severe dyspnea on exertion, fatigue, angina, syncope) AND

iv. Treatment with oral calcium channel blocking agents has been tried and failed , or has been considered and ruled out


If none of the drugs used with a nebulizer are covered , the compressor , the nebulizer , and other related accessories /supplies will be denied as not reasonable and necessary.


Detailed Written Order Requirements:

  • Beneficiary’s name
  • Date of order, and start date if different
  • Detailed description of the DME item being ordered, brand name, model and serial number
  • Name, dosage and concentration of drug(s) being dispensed
  • Specific frequency and duration of administration
  • Quantity to be dispensed
  • Number of refills
  • Treating practitioner’s printed name and NPI
  • Treating practitioner’s signature and date

When albuterol, levalbuterol, or metaproterenol are prescribed as rescue/ supplemental medication for beneficiaries who are taking formoterol or arformoterol , the maximum milligrams/month that are reasonably billed are:

Claims for more than these amounts of drugs will be denied as not reasonable and necessary.

BASIC MANUAL WHEELCHAIR PARTS



Our trained staff member will instruct you and your family on the proper use of your CPAP unit, tubing, and accessories. At the close of your training session you will be able to do the following:

1. Assemble the entire CPAP equipment.

2. Identify each part by name according to the manufacturer of your particular CPAP unit.

3. Correctly apply your nasal mask or nasal pillow.

4. Correctly clean and/or replace all components as directed by manufacturers guidelines.

5. Identify actions to initiate in case of problems or equipment malfunction.


I. DISCUSSION OF DIAGNOSIS, SYMPTOMS AND CPAP THERAPY RATIONALE

A. Understanding the disease state and its effect on patients life and health.

B. Understanding the physiologic mechanism of the disease.

C. Understanding how CPAP therapy helps correct symptoms; what is CPAP and why is it prescribed.

D. The need for compliance with all physicians orders.  

E. Importance of absolute compliance with all aspects of CPAP therapy.

II. APPLICATION/EVALUATION OF THERAPY

A. Patient and/or caregiver to demonstrate ability to:

1. Assemble/disassemble entire patient circuit.

2. Identify each part of the system by name.

3. Correctly and effectively apply the mask.

4. Activate/deactivate the blower unit.

5. Correctly clean and/or replace all components as indicated.

B. Patient must be able to determine adverse effects and take corrective action.

III. PATIENT/FAMILY INVOLVEMENT IN SUCCESSFUL OUTCOME OF THERAPY

A. The importance of closely following the entire treatment program for obstructive sleep apnea.

B. The need for open lines of communication between patient, family, physician, and staff members.

C. The patient should never deviate from or discontinue therapy without permission from the physician.

D. The importance of reporting clinical problems to physician as soon as possible.

E. The importance of reporting equipment problems to Express Rx as soon as possible.

F. The importance of family support and assessment.


** HELPFUL HINTS:

1. Wash your face before using your CPAP unit to remove excess facial oils, to prolong the life of your nasal mask.

2. Once you have been fitted correctly, try to unfasten only one strap when removing the mask to ensure you are maintaining the proper fit.

3. A tighter fit is better, but can be loose as long as there are no air leaks.

4. Keep the back of the headgear flat.

5. If your skin becomes irritated at a pressure point, use a Band-Aid type adhesive strip and contact Express Rx.

6. If you notice the following, please contact your physician:

A. Runny nose

B. Nasal, sinus, or ear pain

C. Obstructive Sleep Apnea symptoms reoccur or persist

D. Lightheadedness or dizziness


Always refer to the manufacturers pamphlet for troubleshooting, cleaning and maintenance.Should the equipment malfunction for any reason, please contact Express Rx 855-392-9308.


PATIENT CHECKLIST OF INSTRUCTIONS FOR PLACEMENT OF BiPAP OR CPAP

1. My doctors order has been explained.

2. Written safety precautions pertaining to this equipment has been presented.

3. Written operating and troubleshooting instructions were presented.

4. Cleaning instructions have been discussed, and written cleaning instructions have been given.

5. Written preventive maintenance and warranty information has been provided. I understand I am responsible for maintenance of purchased equipment.

6. I have performed the procedure to use this equipment in the presence of a representative.

7. I have received the 24-hour emergency phone number, and know to call 911 for medical emergencies.

8. I understand additional supply items can be ordered through Express Rx Inc.

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