Pulmonology Coding Alert

Question: Our pulmonologist was recently credentialed to perform hyperbaric oxygen therapy (HBO). We have been billing with the standard HBO code, 99183. When should we use G0167? 

Florida Subscriber
Answer: HBO, a procedure increasing in popularity, treats patients with a variety of problems by placing them inside a hyperbaric chamber pressurized with medical-quality air. The process increases the amount of oxygen carried in all body fluids.
 
It should be reported with 99183 (physician attendance and supervision of hyperbaric oxygen therapy, per session) for each new session of HBO. Bill pretreatment, patient preparation or patient education with the appropriate E/M code. Because a physician is not always needed to perform the procedure, G0167 (hyperbaric oxygen treatment not requiring physician attendance, per treatment session) can be used.
 
"Physician attendance" in the descriptor of each code is the source of confusion. Different states have different  rules. For example, Utah requires that the physician write a note at the beginning of the session, at least every 30 minutes during each patient treatment, as well as at the end, and have a response time of one minute for an emergency. Arkansas states that "the physician be in continuous attendance within the immediate hyperbaric oxygen area (e.g., within the same room as the hyperbaric oxygen monoplace chamber, or within the hyperbaric oxygen multiplace chamber)." Some local payers cover the procedure only in the setting of a hospital inpatient or outpatient. Because reimbursement for G0167 is left to the carrier's discretion, check with local carriers before using. 
 
The respiratory conditions that can be treated with HBO include carbon monoxide poisoning (986, toxic effect of carbon monoxide), arterial embolism and thrombosis (444.xx, arterial embolism and thrombosis), and decompression sickness (993.3, caisson disease [e.g., decompression sickness]). For treating decompression sickness through HBO, the cause must be diving, not by altitude as was initially, but erroneously, communicated by CMS.