Pulmonology Coding Alert

Question: Our pulmonologist recently passed certification exams to perform hyperbaric oxygen (HBO) therapy. How should we code for this procedure for Medicare patients? Also, which diagnosis codes apply?

Texas Subscriber Answer: A physician can perform HBO for many different reasons, but your pulmonologist may use this form of therapy to treat specific pulmonary conditions caused by carbon monoxide poisoning (986, Toxic effect of carbon monoxide), arterial embolism and thrombosis (444.x), and decompression sickness (993.3, Caisson disease). For each new session of HBO, report 99183 (Physician attendance and supervision of hyperbaric oxygen therapy, per session). You should bill pretreatment, patient preparation or patient education separately with an E/M code (99211-99215). When the registered nurse doesn't need the pulmonologist to attend the procedure, use G0167 (Hyperbaric oxygen treatment not requiring physician attendance, per treatment session).

Local carriers have specific documentation guidelines for submitting an HBO claim. For example, Blue Cross Blue Shield of Oregon's requirements include:
   The medical record should reference prior therapies that have failed, the adjuvant surgical and antibiotic therapy, any appropriate culture, and sensitivity reports.
   Your pulmonologist's records should describe findings, treatment rendered, observations addressing response to therapy, and complications of therapy.
   Include evidence that cardiopulmonary resuscitation was immediately available during the hours of the HBO chamber operation.