How to Be Paid for Using HBO
Published on Tue Aug 01, 2000
Hyperbaric oxygen therapy (HBO) a medical treatment in which a client breathes pure oxygen under greater-than-normal atmospheric pressure is a relatively new procedure that is gaining in popularity. Perhaps because HBO is relatively rare, it seems to be a prime target for payers seeking to minimize costs. Nevertheless, there are codes that are being paid.
Currently, there are about 500 HBO chambers in the United States. An HBO client is placed inside a hyperbaric chamber, which is then pressurized with medical-quality air, similar to the pressurized cabin of a jet airplane. This treatment can be performed by a variety of doctors in an inpatient or outpatient setting. It leads to a substantial increase in the amount of oxygen carried in all body fluids including plasma, cerebrospinal fluid, and lymph and intracellular fluids. It can be used in wound healing and as part of an overall medical care plan treating a wide variety of illnesses and injuries. HBO most often is used by environmental doctors but critical care doctors, pulmonologists and anesthesiologists are being trained for it as well.
What Are the HBO Reimbursement Issues?
Medicare approves the treatment for a few respiratory- related conditions such as 986 (toxic effect of carbon monoxide), 444.xx (arterial embolism and thrombosis) and 993.3 (caisson disease [e.g., decompression sickness]). Coders should be cautioned that some of the earlier communications from Health Care Financing Administration (HCFA) contained errors, such as including decompression sickness caused by altitude as a covered condition, when in fact it should have been decompression sickness caused by diving.
The standard code for use of this therapy is 99183 (physician attendance and supervision of hyperbaric oxygen therapy, per session), with each new session using a separate instance of the same code. Any pretreatment, patient prep or patient education should be billed under the appropriate evaluation and management (E/M) code.
In fact, because many facilities reported that a physician is not always necessary to perform the procedure, a new code was established recently, G0167 (hyperbaric oxygen treatment not requiring physician attendance, per treatment session). Reimbursement for this code is left to the carriers discretion, so it is important to check before authorizing the service without a physician present. According to Caroline E. Fife, MD, associate professor, department of anesthesiology at the University of Texas in Houston and immediate past president of the Undersea Hyperbaric Medical Society (UHMS), the new code is a little misleading. It is particularly confusing to require a physician to generate a charge for which there is a practice-expense reimbursement, but for which no actual work is being done.
Who Can Perform HBO?
Credentialing and physician attendance are two of the more hotly contested concerns among HBO advocates [...]
