Opinion on performing HBO treatments over 60 treatments for complex cases

The insurance has authorized additional therapies beyond 60 sessions. The podiatrist for the HMO wants him to continue. He received 40 sessions March through June 2022. Then 20 more sessions August.

Concern is safety beyond the 60 sessions, not authorization. Any guidance on standard of practice regarding the topic and how best to counsel the patient regarding risks, i.e. cataract

Sep 29, 2022 by John Lindberg, MD

1 replies

Mike White
MD, UHM, MMM, CWS

John,

My assumption is that this is for a chronic refractory osteomyelitis. In general, you can treat longer than "standard practice" but you need to have really good documentation as to why you are continuing to treat the patient. That is justification. Additionally, to answer the question about risks with respect to cataracts, the Palmquist series (https://pubmed.ncbi.nlm.nih.gov/6691953) showed that is takes somewhere around 150 HBO treatments before a new cataract that is not pre-existing may form, if your patient has pre-exiting cataracts they may progress more quickly. None of is not in stone, so yes I would certainly discuss the POTENTIAL risks of developing cataracts and hyperbaric myopia.

Sep 29, 2022

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