Sarah, this is indeed a challenging case. You have been thorough to describe your findings to us —helpful. BUT, to Medicare (more specifically your fiscal intermediary), you have described a hodgepodge that makes no sense and would likely not be approved.

Others, feel free to jump in and give opinions.

If this were my patient, and I was doing an intake consultation, I would not address any of the confounding diagnoses and focus specifically on the STRN of the pubic area. I’m sure on physical examination that there are several other findings that you did not include, such as any open skin wounds, definite changes due to radiation … such as complete pubic hair loss in the radiated field, vaginal wall non-healing wounds, vaginal atrophy, etc. These (no matter how trivial) complete the diagnosis of STRN with non-healing latent effects of radiation in normal tissues (LENT).

You have stated that the patient is being treated for osteomyelitis, but there is no record of surgical procedure, debridement, culture, and sensitivity, etc … so, you really haven’t defined OM from a clinical standpoint for HBOT. That requires the above, plus appropriate antibiotics for at least six weeks, and then recurrence in the same location. And, I don’t see reference of an open, draining wound or fistula …. So, do not tell this story to Medicare. It will not pass muster.

Based on your fiscal intermediary, the diagnosis of ORN is limited entirely to the mandible. When I have a mixed problem like your patient, I suggest telling the story of multiple tissues being involved in the radiation area, with the final diagnosis (from an HBOT standpoint) of STRN.

This is just my opinion, I would encourage others to chime in here.

gene