These are the guidelines for 99183 for the local Medicare contractor in my area (Novitas Solutions):
HBO therapy performed in a hospital outpatient department is an “incident to” service and requires physician supervision. This requirement is presumed to be met when services are performed on the hospital premises (i.e., certified as part of the hospital and part of the hospital campus); however, in all locations, it is recommended that the physician be present during the ascent and descent portions of the HBO treatment.
“Immediately available” in the context of HBO therapy performed in a on-campus provider-based department or in an off-campus hospital site is defined as the supervising physician or qualified NPP present in the office suite or a maximum response time to the chamber of five minutes. The supervising physician or qualified NPP must be present in the office suite for HBO therapy performed in a non-hospital setting.
NOTE: The Office of the Inspector General (OIG) links the quality of care to the physical presence of the physician during the entire treatment for the purpose of managing the patient's overall care, as identified in the October 2000 report, ‘Hyperbaric Oxygen Therapy, Its Use and Appropriateness.'
1. All documentation must be maintained in the patient's medical record and available to the contractor upon request.
2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the physician or non-physician practitioner responsible for and providing the care of the patient.
3. The submitted medical record should support the use of the selected ICD-9-CM code(s). The submitted CPT/HCPCS code should describe the service performed.
4. Documentation must include a history and physical that clearly substantiates the condition for which HBO is recommended including any prior medical, surgical and/or HBO treatments.
5. Documentation of the procedure including ascent time, descent time and pressurization level and a treatment plan identifying timeline and treatment goals must be maintained in the patient's medical record.
6. Documentation must support the involvement of a physician skilled in the management of systemic illness, particularly diabetes management, and particularly cardiovascular and neurovascular complications.
7. Documentation must support that the setting provides the required trained emergency response team to ensure the patient's safety if a complication occurred.
8. For diabetic wounds of the lower extremity, the Wagner classification of the wound and the failure of an adequate course (at least 30 days) of standard wound therapy must be documented at the initiation of therapy:
a. Documentation must demonstrate an ulcer with bone involvement (osteomyelitis), or localized gangrene, or gangrene of the whole foot.
b. Documentation of standard wound care in patients with diabetic wounds per the NCD must include:
§ assessment of a patient's vascular status and documentation of correction of any vascular problems in the affected limb;
§ documentation of optimization of nutritional status;
§ documentation of optimization of glucose control;
§ documentation of debridement by any means to remove devitalized tissue;
§ documentation of maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings;
§ documentation of efforts for appropriate off-loading; and
§ documentation of necessary treatment to resolve any infection that might be present.
c. Failure to respond to standard wound care occurs when there is no documentation of measurable signs of healing for at least 30 consecutive days. The medical record must include, at a minimum, a wound evaluation at least every 30 days during administration of HBO therapy.
Documentation Requirements
1. All documentation must be maintained in the patient's medical record and available to the contractor upon request.
2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the physician or non-physician practitioner responsible for and providing the care of the patient.
3. The submitted medical record should support the use of the selected ICD-9-CM code(s). The submitted CPT/HCPCS code should describe the service performed.
4. Documentation must include a history and physical that clearly substantiates the condition for which HBO is recommended including any prior medical, surgical and/or HBO treatments.
5. Documentation of the procedure including ascent time, descent time and pressurization level and a treatment plan identifying timeline and treatment goals must be maintained in the patient's medical record.
6. Documentation must support the involvement of a physician skilled in the management of systemic illness, particularly diabetes management, and particularly cardiovascular and neurovascular complications.
7. Documentation must support that the setting provides the required trained emergency response team to ensure the patient's safety if a complication occurred.
8. For diabetic wounds of the lower extremity, the Wagner classification of the wound and the failure of an adequate course (at least 30 days) of standard wound therapy must be documented at the initiation of therapy:
a. Documentation must demonstrate an ulcer with bone involvement (osteomyelitis), or localized gangrene, or gangrene of the whole foot.
b. Documentation of standard wound care in patients with diabetic wounds per the NCD must include:
§ assessment of a patient's vascular status and documentation of correction of any vascular problems in the affected limb;
§ documentation of optimization of nutritional status;
§ documentation of optimization of glucose control;
§ documentation of debridement by any means to remove devitalized tissue;
§ documentation of maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings;
§ documentation of efforts for appropriate off-loading; and
§ documentation of necessary treatment to resolve any infection that might be present.
c. Failure to respond to standard wound care occurs when there is no documentation of measurable signs of healing for at least 30 consecutive days. The medical record must include, at a minimum, a wound evaluation at least every 30 days during administration of HBO therapy.