Can a patient who has diabetes and has a BKA stump with Acute Osteo be Wagner III for HBO

Pt had amputation 2 years ago and recently developed acute infection and draining wound. MRI and inflam. markers = dx with Acute Osteomyelitis 10cm of tibia involved. On antibiotics, local debridement.
1. Physician wants to use DFU for HBO citing the NCD codes for "Lower Extremity"
2. If necessary, will wait the 6-8 weeks for Chronic Osteo dx but has not had bone debridement. There is not a contraindication for surgery or reason to believe bone debridement would destabilize his limb.
Looking for clarification that
Wagner is foot only DESPITE the lower limb codes and
Chronic Osteo, the treatment is Medical and Surgical.
Thanks for any direction I can share that would facilitate consensus. Of course, I have used my excellent WoundReference Articles.

Mar 20, 2025 by Kim Posten, RN

2 replies

Craig Lindsey
MD

HI Kim, thanks for the question. The Wager grading system is only for the foot and ulcers that may occur there. This patient no longer has a foot on this leg and that would make the Wagner system irrelevant. You do however have osteomyelitis and I'm guessing that this is now close to meeting criteria for chronic osteomyelitis (6 weeks). What has been the time course of antibiotic therapy? And is surgical debridement of the infected bone an option? Would this leave the patient with a high BKA? or would it have to be an AKA given the amount of osteomyelitis seen on imaging? Ideally, surgical debridement with or without a more proximal amputation in conjunction with antibiotics would be the most appropriate course. If the patient meets criteria for chronic osteomyelitis during this period and surgery cannot be done for whatever reason (patient may not want this) then HBO should be an option.

Hope this helps

Mar 20, 2025

Kim Posten
RN

Thanks so much. I didn't consider that a patient who does not want surgery (even if it is needed and it is not contraindicated) could still go forward with HBO without the nidus of infection debrided. That gives me a new perspective on the CROM patient. I suppose if the markers are improving, that would support efficacy. Again, thanks!

Mar 20, 2025

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