G47.33 — Obstructive Sleep Apnoea
Denied56M · investigation — Second polysomnography
Insurer Rationale
Repeat sleep study is not medically necessary while symptoms are controlled and there has been no material clinical change.
Reasoning Chain
The patient is improving, not drifting. Repeating polysomnography without weight change, symptom recurrence, or equipment concern does not alter management.
Reasoning Chain
Findings
Snoring improved, Epworth score 6, Stable weight, CPAP adherence 6.5 h/night
Diagnosis
Obstructive sleep apnoea (stable on cpap)
Assessment
OSA response review — Current treatment is effective and there is no trigger for repeat diagnostic testing.
Guideline action
Continue current CPAP management without repeat sleep study
Verdict
Denial is clinically correct because a second sleep study would not change care in a stable, well-controlled patient.
Clinical Evidence
NICE Guideline NG202 — Obstructive sleep apnoea/hypopnoea syndrome
Follow-up and reassessment
Repeat sleep studies are reserved for significant clinical change or treatment failure, not routine repeat testing.
AASM Clinical Practice Guidance (2023)
Repeat diagnostic studies
Stable symptom control with adequate PAP adherence does not justify repeat polysomnography.