Good evening, Shanna … I’ll take a crack at this, but I welcome others to join in since this is both a clinical and billing question.
1. Does Medicare cover this? Well, that depends entirely on your fiscal intermediary. Some do and some don’t. So, job one is to get a copy of the FI’s HBOT indications and what it does/doesn’t cover.
2. If the FI does cover this indication, what criteria does it require? Some require a TCOM in the periwound tissue to show that it is at risk. Others do not.
3. If you proceed, the clinical judgment and DOCUMENTATION will be the key to coverage vs. fraud/abuse or non-reimbursement. I think you’ve provided good documentation for us in the case snippet above. But, I would document thoroughly, knowing that you will likely be audited on it. Start with the history of leg lengthening surgery with tenuous skin survival and skin necrosis. Don’t shoot yourself in the foot here. I wouldn’t include that it was a cast that caused the problem … just that the patient nearly failed the flap on the first surgery, and that this required x, y, and z procedures to salvage the outcome.
4. Finally, I would conclude that this operation is again in the area of previous skin necrosis and that the surgeon had contacted you for hyperbaric support prior to and following this surgical adventure.
It would help if the surgeon noted that the skin was tenuous and he/she asked for your consultation and hyperbaric support. This just makes the audit more clean.
And, agree with the surgeon that this is going to be 20 treatments pre-op and potential for 10 treatments postop.
OK … there you have it … $2 (US) will get you a soft drink … with that opinion …
:-)))
Gene
![]()
![]()