Is surgery the only option for treating sleep apnea or snoring
I do predominantly the line share of sleep apnea surgery in our department. I collaborate closely with the pulmonologists, who are the sleep medicine s. Those are the s that help diagnose and treat sleep apnea, as well. If those patients fail their, their medical or their conservative therapy, that's typically when they get sent to see me for surgical considerations to, to look at potential cures for their apnea. It's not uncommon for me to see a lot of patients for, who come in for snoring complaints and, you know, are wondering whether or not they have sleep apnea. So sleep apnea is condition where you actually stop breathing at night.
Snoring is somewhere on that spectrum, towards the more mild, you know, milder end of that spectrum. But, you know, really the only way to determine if you have sleep apnea, the gold standard of testing, is really getting a sleep study. And that's an overnight, monitored study where patients, you know, sleep in a room that's similar to a hotel room but they're being monitored and they're hooked up, you know, for sound so to speak with different monitors and cables on them. And that's really our best test to diagnose sleep apnea. The treatment for sleep apnea is typically a nonsurgical therapy; something called CPAP,
which stands for Continuous Positive Airway Pressure. And it's the patients that don't tolerate their CPAP who end up seeing me for surgical considerations. And there's a number of reasons why patients may not tolerate their CPAP. But there are some surgeries that can be helpful in patients who are not tolerant of their medical therapy. And I offer a variety of surgeries including nasal surgery, a variety of palatal surgeries for the kind of tonsil and soft pallet region and then also a variety of tonguebased procedures, as well. But we typically see a patient back after their procedure in about three weeks to recheck everything, make sure that they're healing okay.
After that, I normally recheck a sleep study in about three months after their surgery, just to give everything a chance to heal and to scar. And we, you know, make further recommendations based on the result of their followup sleep study after their surgery. We're exploring the, a new technology now which is actually a nerve stimulator for sleep apnea. It's an implantable device, very similar to a pacemaker that goes into the patient's chest. And there's an electrode that will actually stimulate the nerve that goes to the tongue to provide the tongue with a little bit of more tone when they're sleeping at night, and thereby eliminating their sleep apnea.
Obstructive Sleep Apnea versus Central Sleep Apnea
Obstructive sleep apnea is when the airwaybecomes narrowed or obstructed and you're making the effort to breathe but we do notsee any flow in air movement coming from your nose or mouth. Where central sleep apnea occurswhere your brain forgets to tell your body to breathe. If we're looking at it from avery simplistic term and so we do not see the drive to breathe. So the first step isto come into the and be seen by one of our physicians in the sleep medicine .We'll go through a questionnaire and try to determine what risk factors we think you havefor sleep apnea such as obesity, snoring, daytime sleepiness and then if we think thatyou have a high risk for meeting those criteria
then we would set you up for a sleep studyeither in your home to do an overnight sleep study or in our laboratory, depending on yoursituation. The CPAP can be used to treat both conditions and, in some patients, that isenough. However, there are some patients that have more complex types of central sleep apneathat require more complicated types of machines to treat that condition. Obstructive sleepapnea actually has been linked to a lot of other problems such as high blood pressureand then, you know, difficulty functioning during the day. If it goes untreated for along period of time there's an increased risk of early heart problems and those types ofthings.
Medical Coding Basics Cardiology Part 2
I grabbed another one, and again it is herefor a sixmonth check. These are routine, very common cases where a person has a cardiacproblem. Again, I'm going to go ahead and slide down to the bottom. I always like towork from the bottom up. I see that our patient has sleep apnea, hypertension and hypercholesterolemia. Then, he not only listed what the diagnosiswas, but actually tells you what he's doing about it or the status of it. Sleep apnea,using oral device as prescribed; so he's probably got a sleep apnea machine that hesleeps with. Hypertension, well controlled on above medication. Now, even though it saysit's well controlled, he has to take a medication
or he would have hypertension; so that isdefinitely codable. Then, same thing with his cholesterol, it's adequately controlledon above medication. The plan is, everything is going to continue and he wants to do anecho and office visit in six months. I'm going to slide back up to the top andI'm going to start looking at our problem list, again you don't code off of a problemlist because it can be copied and pasted. Again, you want to follow your office or yourcompany's guidelines about things like that problem list. Here we've got a person with afib, but nowhe's made a point to say â€œnone since 20XX.â€�
That tells me that I'm not going to codethat, either saying â€œNo, he does not have it.â€�It's not that they're taking medicationis the reason why they don't have it. He's saying that there's not been any reported.Hypertension, hyperlipidemia and sleep apnea and that they're using that oral device,the machine. Then, I'm going to go down to look at thesemedications, Cardizemâ€¦ I know what all of these are, but I went ahead and wrote downwhat some of these are because if you are not familiar, you need to be familiar withthe medications. You can go to drugs , webmd , there's all kinds, just Googleit, it will tell you.
I'm going to go to this history, the thingsthat jumped out at me, one, the palpitations he didn't address it. In other words, thepalpitations aren't something that we're going to worry about. He is using his oraldevice as prescribed. That constitutes the sleep apnea. They did a lab for the cholesteroland the triglycerides. Now we know he's actively being treated. Again, they checkedthe blood pressure. Over here, look, nothing is wrong here with the cardiovascular, scannedall of these, nothing jumps out at you. And you need to know these terms, â€œBS x4quadsâ€� you need to know what they mean. â€œNo carotid bruits,â€� they're talkingabout the carotid arteries. The â€œneck veins
are flatâ€� meaning they're not bulgingout that would indicate an issue with your blood pressure. â€œNo murmurs, clicks, orgallopsâ€� if you don't know what a murmur, a click, and a gallop sounds like, you canactually go to YouTube and you can hear them. It's really cool, different types of breathingtoo. So, we're limited to â€“ because I alwayswant to code things sleep apnea, hypertension, and the hypercholesterolemia. This persongot a 99214 as well. The pure hypercholesterolemia is 272.0, the 401.9 for the hypertension,and sleep apnea is 780.57. Those are very, very common codes especially the first two.You probably have them memorized even though
you're not supposed to memorize codes, youreally can't help it when you do them over and over. What about those medicationsé Cardizem isused for hypertension. Metoprolol is Lopressor and you may see that advertised on TV, a bloodpressure medication, beta blocker. What about this one,that it's like, â€œHuh! I don'tknow what that medication was.â€� It's actually Tambocor and it's for an irregular heartbeatrhythm, and Pravastatin is for cholesterol. Again, those are the things that you needto be aware of when you're doing cardiology. You need to know medications pretty well.Don't worry if you don't know them very