FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES
LCD Number
AC1300
Contractor
Name
First Coast Service
Options, Inc.
Contractor
Number
09101 – Florida
09201 – Puerto Rico/Virgin Islands
LCD Title
Hyperbaric Oxygen
Therapy (HBO Therapy)
Coding
Guidelines
For Critical Access Hospitals (CAHs) electing
Method I, HBO therapy is reported under revenue code 940 along with HCPCS codes
99183.
Payment to Critical Access Hospitals
(electing Method I) is made under cost reimbursement. For Critical Access Hospitals electing Method II, the technical
component is paid under cost reimbursement and the professional component is
paid under the Physician Fee Schedule.
CPT code 99183
Physician attendance and supervision of hyperbaric oxygen therapy, per session,
is reported for physician attendance of each session of hyperbaric oxygen
therapy. Any services and/or procedures
provided in addition to the physician attendance and supervision (eg, E & M
services, wound debridement, transcutaneous PO2 determinations) in the hyperbaric
oxygen treatment facility, in conjunction with hyperbaric oxygen therapy should
be reported separately.
E &M services
billed on the same day of HBO therapy require a significant, separately
identifiable service, unrelated to the HBO therapy or the condition which
necessitated the HBO therapy and modifer 25 must be applied to the E & M
service. Documentation must reflect the
necessity, as well as a description of services provided.
Hospitals providing
hyperbaric oxygen (HBO) therapy should continue to report this service using
HCPCS code C1300, Hyperbaric oxygen under pressure, full body chamber, per 30
minute interval. Effective January 1,
2005, the following may be included in calculating the total number of
30-minute intervals billable under C1300:
(1)
time
spent by the patient under 100% oxygen;
(2)
descent;
(3)
airbreaks;
and
(4)
ascent.
NOTE: A physician
order for a 90-minute HBO treatment typically means that the physician desires
that the patient be placed under 100% oxygen for 90 minutes. In order to safely achieve 100% oxygen for
90 minutes, additional time may be needed to provide for the descent,
airbreaks, and ascent. Therefore, the total number of billable 30-minute
intervals would not be based solely on the amount of time noted on the
physician order. In calculating how many 30-minute intervals to report,
hospitals should take into consideration the time spent under pressure during
descent, airbreaks, and ascent.
Additional units
may be billed for sessions requiring at least 16 minutes of the next 30-minute
interval. For example, 2 units of HCPCS
code C1300 should be billed for a session in duration of between 46 and 75
minutes, while 3 units should be billed for a session in duration of between 76
and 105 minutes. Furthermore, 4 units of HCPCS code C1300 should be billed for
a session in duration of between 106 and 135 minutes. HBO is typically
prescribed for an average of 90 minutes, which hospitals should report using
appropriate units of HCPCS code C1300 in order to properly bill for full body HBO
therapy. In general, we do not expect that a physician order for 90 minutes of
HBO therapy would exceed 4 billed units of HCPCS code C1300.
EXAMPLE:
Physician
orders and patient receives 90 minutes of therapeutic HBO;
Patient
requires and receives 10 minutes of descent time;
Patient
requires and receives 10 minutes of air breaks;
Patient
requires and receives 10 minutes of ascent time.
The above example would be billed correctly by reporting 4 units of HCPCS code C1300, reflecting the sum of the 90 minutes of therapeutic HBO, 10 minutes for descent, 10 minutes for air breaks, and 10 minutes for ascent.
Per CMS Manual System, Pub. 100-3, Medicare
National Coverage Determinations, Chapter 1, Section 20.29, for each of the
fifteen covered conditions, the following diagnosis codes should be utilized:
1.
Acute carbon monoxide
intoxication - Diagnosis 986
2.
Decompression illness -
Diagnosis 993.2, or 993.3
3.
Gas embolism - Diagnosis
958.0, or 999.1
4.
Gas gangrene - Diagnosis
040.0
5.
Acute traumatic
peripheral ischemia - Diagnosis 902.53, 903.01, 903.1, 904.0 or 904.41
6.
Crush injuries and
suturing of severed limbs - Diagnosis 927.00-927.09, 927.10-927.11,
927.20-927.21, 927.8, 927.9, 928.00-928.01, 928.10-928.11, 928.20-928.21,
928.3, 928.8-928.9, 929.0-929.9, or 996.90-996.99
7.
Progressive necrotizing
infections: (necrotizing fasciitis) - Diagnosis 728.86
8.
Acute peripheral
arterial insufficiency associated with arterial embolism and thrombosis -
Diagnosis 444.21, 444.22, 444.81
9.
Preparation and
preservation of compromised skin grafts (flaps) - Diagnosis 996.52
10. Chronic refractory osteomyelitis, unresponsive to
conventional medical and surgical management - Diagnosis 730.10-730.19
11. Osteoradionecrosis as an adjunct to conventional
treatment - Diagnosis 526.89, 909.2
12. Soft tissue radionecrosis as an adjunct to
conventional treatment - Diagnosis 990, 909.2
13. Cyanide poisoning - Diagnosis 987.7 or 989.0
14. Actinomycosis, only as an adjunct to conventional
therapy when the disease process is refractory to antibiotics and surgical
treatment. - Diagnosis 039.0-039.9
15. Treatment of diabetic wounds of the lower extremities
– Diagnosis 250.70-250.73, 250.80-250.83, 707.10, 707.12-707.15, and 707.19.
Other
Comments
N/A
Revision
History
|
Date |
Revision |
|
02/16/2009 –
Florida |
Original |
Document formatted:
01/10/2006 (JG/st)