Wiki Coding for hyperbarics

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tmorehart

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Is there anyone out there that has extensive knowledge of coding for HBO therapy? My provider wants to put a patient in for a diabetic foot ulcer who also has osteomyelits. The osteo is not chronic so we can't put the patient in for that and the 30 days of prior treatment for the DFU have shown improvement, however the provider states that the patient will never heal or heal only to reopen due to the osteo. He assumes that the patient will probably end up with a toe amp and same issue non-healing.

Has anyone else ever coded a similar case. Just want to make sure that we are meeting LCD requirements for this.
 
We had a patient with a similar diagnosis. We went ahead with the HBO therapy, knowing that Medicare would not approve it. When we recieved the first denial, the physician sent a letter of medical necessity explaining why it was necessary. Our MAC (NGS) approved it and subsequenst HBO treatments. So, it is possible - just may have to jump a few hoops and have a little patience.
 
We are NGS as well. I will pass this along to the provider. Thank you so much for your reply. I don't have any wound care coding friends to ask on this one :)
 
The treatment for osteo is hyperbarics, antibiotics and surgical removal of the osteo. These should all be addressed.
As for coding you would code the reason for HBO first for the HBO dive. There are 15 Medicare approved CPTs for HBO they are listed on your LCD.
This is the reason that serial billing for wound care is not a good idea. If the patient comes in for a debridement one day and has hbo the next the primary CPTs need to be changed. The debridement would code the wound as primary but the hbo would need to code the osteo code listed on the approved reasons for hbo on the lcd.
 
Hyperbarics

I too work in wound care and Hyperbaric medicine and we see A LOT of DFU that could benefit from HBO. Unfortunately as we know all DFU's don't qualify unless ALL the criteria has been met. My local LCD's state not only must a patient fail 30 consecutive days of standard wound care but also must be; a Wagner 3 ulcer, have documented counseling regarding their glycemic control for their DM, been evaluated and treated by a vascular surgeon and surgically treated if the patient has a correctible condition.
I don't know who your MAC is but out here in California our new contractor is NORIDIAN and so far from what I've seen they are going over our claims with a fine tooth comb. Nothing wrong with that as we should be practicing within the guidelines. :):)
 
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