Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

 

 

 

MP 1.01.06

 

Home Apnea Monitoring


 

Medical Policy    
Section
Durable Medical Equipment
 
Original Policy Date
3/31/96
 

Last Review Status/Date
Reviewed with literature search/3:2013

Issue
3:2013
  Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

 


 

Description

Home apnea monitors monitor respiratory effort and heart rate in order to detect episodes of apnea. They have been proposed for a variety of indications including but not limited to children at increased risk of sudden infant death syndrome (SIDS) and children who have experienced a life-threatening event.

Home apnea monitors generally monitor respiratory effort and heart rate, and are typically utilized to monitor central apnea of prematurity in newly discharged at-risk or high-risk premature infants (infants are at increased risk of cardiorespiratory events until 43 weeks’ post-gestational age). An alarm will sound if there is respiratory cessation (central apnea) beyond a predetermined time limit (e.g., 20 seconds) or if the heart rate falls below a preset rate (bradycardia) to notify the parent that intervention (stimulation, mouth-to-mouth resuscitation, cardiac compressions) is required. Unless an oximeter is added to the two-channel devices, home apnea monitors are not effective at detecting obstructive sleep apneas. False alarms due to movement artifact are common with pulse oximeters, and these devices are not intended for the diagnosis of sleep-disordered breathing in a child.

Sudden infant death syndrome (SIDS) is the sudden death of an infant under one year of age, the circumstances are unexplained after a thorough investigation that includes autopsy, examination of the death scene, and review of the family history. As a means to decrease the incidence of SIDS, in the 1970’s cardiorespiratory monitoring was suggested. However over time, scientific medical studies have failed to establish that the use of home monitoring reduces the incidence of SIDS. The American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome in 2005, reiterates the recommendations of previous policy statements that home monitoring should not be used to reduce the incidence of SIDS. (1,2) The American Academy of Pediatrics further recommends that proven practices should be promoted to reduce the incidence of SIDS which includes supine sleeping, pre-and post-natal exposure to cigarette smoking and a safe environment. The “Back to Sleep” Campaign initiated in 1994 by the National Institute of Child Health and Development (NICHD), Maternal Child Health Bureau of Human Resources and Services Administration, American Academy of Pediatrics and organizations concerned about SIDS is a national process to educate health care professionals, parents and caregivers about the significance of placing infants in the supine position to sleep to reduce SIDS. (3) Since that time, statistics from the CDC 1998-2006 have shown that the incidence of SIDS has declined by 50%. This has in turn led to an overall decrease in utilization of home apnea monitors. Appropriate utilization of home cardio-respiratory monitoring may be used in the circumstances outlined in the policy section.

Regulatory Status
A number of infant apnea monitors have been cleared for marketing by the U.S. Food and Drug Administration (FDA). One device is the SmartMonitor 2 Apnea Monitor (Philip Children’s Medical Ventures, Respironics), which was cleared for marketing through the 510(k) process in October 2003. The intended use is for continuous monitoring of respiration, heart rate, and SpO2 of infant patients in a hospital or home environment.

 


 

Policy

Home cardiorespiratory monitoring (pneumogram)may be considered medically necessary in infants less than 12 months of age in the following situations:

  • Those who have experienced an apparent life-threatening event; OR
  • Those with tracheostomies or anatomic abnormalities that make them vulnerable to airway compromise; OR
  • Those with neurologic or metabolic disorders affecting respiratory control, including central sleep apnea; OR
  • Those with chronic lung disease (i.e., bronchopulmonary dysplasia), particularly those requiring supplemental oxygen; continuous positive airway pressure; or mechanical ventilation.

Home cardiorespiratory monitoring (pneumogram) is considered not medically necessary in infants with any siblings with a history of sudden infant death syndrome (SIDS), but without at least one of the indications cited.

Home cardiorespiratory monitoring (pneumogram) in all other conditions, including but not limited to the diagnosis of obstructive sleep apnea, is considered investigational.

 

 


 

Policy Guidelines

An apparent life-altering event is defined as an episode that is frightening to observe and is characterized by some combination of apnea, color change, marked change in muscle tone, choking, or gagging.

As suggested by a Policy Statement from the American Academy of Pediatrics (see Rationale section, below) the physician should establish a review of the problem, a plan of care, and a specific plan for periodic review and termination. Clear documentation of the reasons for continuing monitoring is necessary should monitoring beyond 43 weeks' postmenstrual age be recommended. Home monitoring is generally not considered appropriate for pediatric patients over 1 year of age.

Home monitors should be equipped with an event recorder.

The following CPT codes may be used:

94772: Circadian respiratory pattern recording (pediatric pneumogram), 12-24 hour continuous recording, infant
94774: Pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, physician review, interpretation, and preparation of a report.
94775: monitor attachment only (includes hook-up, initiation of recording and disconnection)
94776: monitoring, download of information, receipt of transmission(s) and analyses by computer only
94777: physician review, interpretation and preparation of report only

Note: Home cardiorespiratory monitoring is intended, in part, to alert caregivers of the need for intervention at the time of an event in patients with apnea, and is not appropriate for diagnosis of sleep-disordered breathing (central or obstructive).

 


 

Benefit Application

BlueCard/National Account Issues

Coverage for services such as physician visits and diagnostic testing in conjunction with SIDS monitoring should be provided in accordance with individual contracts.

Coverage is usually not provided for:

  • a backup electrical system;
  • parental training sessions, including cardiopulmonary resuscitation (CPR) or instructions in the use of the monitor when identified as a separate charge. These charges are usually included in the rental or purchase fee.

 


 

Rationale

This policy was created in 1996 and was updated in 2003, at which time the policy statement by the American Academy of Pediatrics (AAP) regarding home cardiorespiratory monitoring (i.e., apnea monitoring) was incorporated. (3) The policy was on “no further review” status from 2003 until 2010. Most recently, the policy was updated with a search of the MEDLINE database for the period January 2012 through January 25, 2013

Sudden Infant Death Syndrome (SIDS)

In 2012, Strehle and colleagues published a systematic review of literature on the impact of home monitoring (apnea monitoring, respiratory monitoring or cardiorespiratory monitoring) on mortality in infants at increased risk of SIDS. (4) The review identified 1 pilot study to assess the feasibility of a randomized controlled trial (RCT) evaluating home monitoring and 10 unique case series. The authors concluded that there is a lack of high-level evidence that home monitoring is beneficial in preventing SIDS.

A 2008 review by Halbower of coding, billing, and prescribing information for pediatric home apnea monitors noted that during the 30-year period when home cardiorespiratory monitors were used (prior to AAP safe sleep recommendations), the occurrence of SIDS was not reduced. (5)

As noted in the Background section of the policy, above, a 2011 technical report from the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome does not recommend home apnea monitoring to prevent sudden infant death syndrome (SIDS). (1) The AAP report cites a lack of evidence that home monitors are effective for this purpose.

Other Respiratory Conditions

There is a lack of evidence for use of home apnea monitors in other conditions. For many of these conditions, trials would be difficult to perform due to small numbers of patients and logistic difficulties for these conditions that make enrollment in trials difficult. As a result, the best available recommendations for treatment currently rely on expert consensus.

A consensus document published in 2003 by the AAP Committee on Fetus and Newborn addressed the use of home apnea monitors for other respiratory conditions. (3) The AAP policy statement identified infants who could benefit from home monitoring, not because of an increased risk of SIDS but because of other factors that increase the risk of sudden death. These infants include those who have:

  • experienced an apparent life-threatening event
  • tracheostomies or anatomic abnormalities that make them vulnerable to airway compromise
  • neurologic or metabolic disorders affecting respiratory control
  • chronic lung disease (i.e., bronchopulmonary dysplasia), particularly those requiring supplemental oxygen; continuous positive airway pressure; or mechanical ventilation.

A 2008 review by Halbower of coding, billing, and prescribing information for pediatric home apnea monitors indicated that evidence remains limited regarding whether home apnea monitors improve health outcomes in comparison with the unmonitored infant. (5)

Summary

There is insufficient evidence from published studies and a lack of support from national guidelines for home apnea monitoring to prevent SIDS. For other respiratory conditions, there is also a lack of published evidence; however national guidelines published by the American Academy of Pediatrics have identified specific groups of infants who might benefit from home monitoring because of other factors that increase the risk of sudden death (e.g., tracheostomies, chronic lung disease, etc.). These conditions identified by the AAP as benefiting from home apnea monitor may therefore be considered medically necessary.

Practice Guidelines and Position Statements

The American Academy of Pediatrics Committee on Fetus and Newborn published a policy on home apnea monitoring in 2003. (3) In 2007, the policy was reaffirmed and retired. (6) The document noted that infants who may benefit from home monitoring include those who have experienced an apparent life-threatening event, have tracheostomies, have anatomic abnormalities that make them vulnerable to airway compromise, or have neurologic or metabolic disorders affecting respiratory control, including central sleep apnea, chronic lung disease including bronchopulmonary dysplasia and especially those individuals requiring supplemental oxygen, continuous positive airway pressure or mechanical ventilation. Furthermore, the AAP recommended that “if monitoring is to be used at home, parents and other caregivers must be trained in observation techniques, operation of the monitor, and infant cardiopulmonary resuscitation. Medical and technical support staff should always be available for direct or telephone consultation.”

Medicare National Coverage

There is no national coverage determination.

References:

 

 

 

  1. Task Force on Sudden Infant Death S, Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128(5):1030-9.
  2. National Institute of Child Health and Human Development (NICHD). Safe to Sleep campaign. Available online at: http://www.nichd.nih.gov/SIDS/Pages/sids.aspx. Last accessed January, 2013.
  3. American Academy of Pediatrics Committee on Fetus and Newborn. Apnea, sudden infant death syndrome, and home monitoring. Pediatrics 2003; 111(4 pt 1):914-7.
  4. Strehle EM, Gray WK, Gopisetti S et al. Can home monitoring reduce mortality in infants at increased risk of sudden infant death syndrome: a systematic review. Acta Paediatr 2012; 101(1):8-13.
  5. Halbower AC. Pediatric home apnea monitors: coding, billing, and updated prescribing information for practice management. Chest 2008; 134(2):425-9.
  6. American Academy of Pediatrics (AAP). AAP Publications Reaffirmed and Retired. 2007. Available online at: http://pediatrics.aappublications.org/content/120/3/683.full. Last accessed January, 2013.

 


 

Codes

Number

Description

CPT  No Code 
ICD-9 Diagnosis  770.7  Chronic respiratory disease arising in the perinatal period
  770.81-770.89 Other repsiratpyr problems after birth, code range
ICD-9 Procedure  No Code 
HCPCS  A4556  Electrodes (e.g., apnea monitor), per pair 
  A4557  Lead wires (e.g., apnea monitor), per pair 
  E0618  Apnea monitor, without recording feature 
  E0619  Apnea monitor, with recording feature 
ICD-10-CM (effective 10/1/14) P27.8 Other chronic respiratory disease originating in the perinatal period
  P22.0 Respiratory distress syndrome of newborn
   P22.1 Transient tachypnea of newborn
   P22.8 Other respiratory distress of newborn
   P22.9 Respiratory distress of newborn, unspecified
   P24.81 Neonatal aspiration with respiratory symptoms
   P27.1 Bronchopulmonary dysplasia originating in the perinatal period
   P27.8 Other chronic respiratory diseases in the perinatal period
   P28.2 Cyanotic attacks of newborn
   P28.3-P28.4 Sleep apnea of newborn code range
    P28.5 Respiratory failure of newborn
   P28.81 Respiratory arrest of newborn
   P28.89 Other specified respiratory conditions of newborn
   P28.9 Respiratory condition of newborn, unspecified
   P84 Other problems with newborn
   R68.13 Apparent life threatening event in infant (ALTE)
   Z93.0 Tracheostomy status
ICD-10-PCS (effective 10/1/14)    Not applicable. ICD-10-PCS is for use only on inpatient services. Policy is only for outpatient services.
Type of Service  DME 
Place of Service  Home 

 


 

Index

Apnea, Infant, Home Monitoring
Monitoring, Apnea, Infant
Siblings of SIDS Victims, Home Monitoring
Sudden Infant Death Syndrome (SIDS), Home Monitoring

 


 

Policy History

Date Action Reason
03/31/96 Add to Durable Medicine section New policy
04/15/02 Replace policy Policy reviewed by consensus; new review date only
07/17/03 Replace policy Policy updated and revised based on AAP guidelines
01/14/10 Replace policy Policy returned to active review and updated with literature review; CPT codes added. Statement added; investigational in all other conditions
3/10/11 Replace policy Policy updated with literature review through December 2010; references added and reordered; policy statements unchanged
3/08/12 Replace policy Policy updated with literature review through January 2012. Reference 5 added; other references renumbered or removed. Policy statements unchanged
03/14/13 Replace policy Policy updated with literature review through January 25, 2013. Reference 1 added; other references renumbered or removed. Policy statements unchanged.