If you want to get a basic idea of Hyperbaric Oxygen Therapy (HBO) coding and local coverage policies (LCP) affecting its billing and reimbursement, this article may help you. It may help you get a better understanding of HBO therapy and its coverage under Medicare.
What is Hyperbaric Oxygen Therapy?
Hyperbaric Oxygen Therapy is a form of treatment that involves placing a patient in a pressure chamber and exposing the patient’s body to pure oxygen under increased atmospheric pressure, specifically 100% oxygen at greater than one atmosphere (ATM) pressure.
In a hyperbaric oxygen therapy chamber, the air pressure is increased to three times higher than normal air pressure. This enables the patient’s lungs to get more oxygen than would be possible when breathing pure oxygen at normal air pressure. The patient’s blood carries the oxygen throughout the body, allowing the body to fight bacteria and infection and increase the release of growth factors which promote healing.
Conditions Covered
It is used to treat a number of conditions from decompression sickness, common among scuba divers, to carbon monoxide poisoning, gas gangrene, gas embolism, acute trauma peripheral ischemia and necrotizing fasciitis. It is also used for treatment of crushing injuries and suturing of severed limbs, as well as certain types of diabetic wounds. It is used to treat chronic refractory osteomyelitis, when conventional treatment doesn’t work. It is used as an adjunct treatment for osteoradionecrosis, soft tissue radionecrosis. It is also used to treat cyanide poisoning, and actinomycosis. HBO therapy is an adjunctive treatment used only when loss of function, limb, or life is threatened. The covered conditions represent emergent medical conditions or have occurred secondary to severe systemic illness.
Medicare Coverage
Medicare coverage of HBO is limited to therapy administered in a chamber (including the one-man unit), as HBO is considered therapy that involves exposing the entire body to oxygen. Medicare covers HBO in the setting of a hospital, both inpatient and outpatient.
HBO therapy is covered as adjunctive therapy and must be used in addition to standard wound care, when there is no measurable healing for at least 30 days of standard wound care therapy. Medicare does not cover continuation of HBO therapy if no healing is seen within 30 days of treatment.
Coding for HBO Therapy
The CPT® code for the attendance and supervision of Hyperbaric Oxygen Therapy is 99183; physician or other qualified heath care professional attendance and supervision of hyperbaric oxygen therapy, per session. This code should be reported per session. The time of each session, number of sessions per day and overall length of the HBO therapy varies depending upon the condition being treated.
If separate E/M (Evaluation and Management) services are provided at the same encounter as CPT® code 99183, both services may be reported by appending modifier 25 to the E/M service. It’s important to ensure that the documentation supports the use of the modifier, i.e. separately identifiable service.
HBO therapy should not be confused with therapeutic hypothermia services. Therapeutic hypothermia services are provided when the patient’s body temperature is decreased, after a cardiac arrest or stroke, in order to decrease the injuries and swelling to the brain; thereby improving the patient’s outcome. The patient’s body temperature may be decreased in several different ways such as ice packs, cooling blankets or IV’s. Typically, true hypothermia services are reported as part of the other critical care services being provided to the patient.
In a time of changing reimbursements, wound care billing and coding requires updated knowledge of Local Coverage Policies (LCPs). The problem is that they are constantly changing and require knowledge of Medicare rulemaking to interpret them correctly. Get more information on new local coverage policies in Hyperbaric and Wound care in a webinar by Gloria Miller, an expert in coding, billing and documentation of outpatient wound care. In this session, she will discuss the latest hyperbaric oxygen therapy (HBO) LCDs (local coverage determinations), CPT and ICD-10 codes, with a side by side LCD comparison for wounds and HBO.
