Nocturnal O2 rule changed

Friday, October 31, 2003

WASHINGTON - Patients who qualify for Medicare oxygen based on the results of a sleep study will soon have to show desaturation of 88% or less for at least five cumulative minutes during the test period, according to a September revision of Medicare’s oxygen policy.

Currently, there is no time frame connected to test. Patients can qualify for nocturnal oxygen if they show destaturation of 88% or less for only a second or two. Such criteria makes the doctor’s decision to place a person on oxygen very subjective, said Joe Lewarski, president of Hytech Homecare & Medical Supply in Mentor, Ohio.

The new requirement, which takes effect Jan. 1, 2004, strikes what appears to be an acceptable middle ground. In its draft policy, Medicare proposed changing the qualifying desaturation to five continuous minutes rather than five culmulative minutes. Industry watchers say that criteria is not based on clinical data.

“Five total minutes below 88% in a normal sleep period of six to eight hours is a fairly reasonable request to demonstrate nocturnal hypoxemia,” Lewarski, said.

Patients who qualify for nocturnal oxygen are generally borderline. They don’t qualify for Medicare oxygen when tested in a seated stable condition on room air or while ambulating. They often have some COPD and maybe some secondary congestive heart failure. During the day, they ride the edge, maintaining saturations above 88%. But at night, due to conditions like shallow breathing, they desaturate, Lewarski said.