Nasopharyngoscopy

[SleepMD1]

Could we as sleep physicians do a CME course and then perform/bill for this procedure?

I could see it beeing useful in some adult and most pediatric sleep patients.

Anyone heard/thought about it?

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[OtoHNS]

I would agree that a fiberoptic exam is somewhat useful in an adult but disagree that it makes much difference in a kid. Pretty much any kid with OSA or UARS is going to get a T+A automatically- doesn't matter what the scope looks like. Maybe would be helpful in a kid with recurrent OSA after T+A.

In an adult, it can be somewhat more helpful at trying to identify if there is a specific area that is narrowed (i.e. oropharyngeal obstruction from big tongue base/lingual tonsils), but mostly you just see that everywhere is narrowed.

Personally, I'd prefer if you keep referring patients to us haha. I've seen radiation oncologists and ED physicians who do fiberoptic exams so you could probably do them if you wanted to. Not sure about reimbursement though...

 

[OklahomaFP]

I don't see much of a point in doing this procedure as a sleep doc unless you have the capability to do something about it. Even if you do a fiberoptic scope and see lingual tonsils or some other obstruction, most of us aren't going to go in and do the surgery, we would still likely have to refer to ENT who would probably do their own exam in the office anyways. Seems to defeat the purpose to me...

 

[Faebinder]

I don't see much of a point in doing this procedure as a sleep doc unless you have the capability to do something about it. Even if you do a fiberoptic scope and see lingual tonsils or some other obstruction, most of us aren't going to go in and do the surgery, we would still likely have to refer to ENT who would probably do their own exam in the office anyways. Seems to defeat the purpose to me...

Exactly, you're gonna refer him to an ENT anyway to do the surgery. They are better off doing it themselves to be more comfortable with the anatomy.

 

[SleepMD1]

Thanks for the input!

I've had a few pediatric patients that were several years s/p T&A and had some residual OSA. I have been sending them to ENT to evaluate for lingual tonsils/adenoidal regrowth and perhaps surgical intervention. As OklahomaFP and Faebinder noted, if they do need surgery, then me doing a fiberoptic exam would not be necessary. But what about if that exam was negative, then I could jump to CPAP or some other treatment?

 

[OklahomaFP]

If a patient has residual OSA, then CPAP or any other alternative treatment is ALWAYS an option, you just have to educate the patient on how effective those treatments would be. CPAP is effective, but compliance is the issue. Other alternatives may be possible choice depending on severity of the residual OSA.

Again I think if you were concerned, I'd still send to an ENT i trusted to do the exam. If its negative, they could then refer back to you for medical management of the OSA.