Medical Billing Tips for Hyperbaric Oxygen (HBO) Therapy

Hyperbaric Oxygen (HBO) Therapy is a safe and effective treatment that may be used as part of a treatment plan to help heal many types of wounds. This treatment involves breathing in pure oxygen while inside a sealed chamber whose air pressure is significantly higher than normal atmospheric pressure. The air pressure inside a hyperbaric oxygen chamber is about two and a half times greater than the normal pressure in the atmosphere. This “hyperbaric” (or high pressure) dose of oxygen helps your blood carry more oxygen to organs and connective tissues to promote wound healing. 

Coverage for Hyperbaric Oxygen (HBO) Therapy

Hyperbaric Oxygen (HBO) is most often used in combination with other treatments. HBO therapy is covered as adjunctive therapy only after there are no measurable signs of healing for at least 30 days of treatment with standard wound therapy and must be used in addition to standard wound care. Standard wound care in patients with diabetic wounds includes: assessment of a patient’s vascular status and correction of any vascular problems in the affected limb if possible, optimization of nutritional status, optimization of glucose control, debridement by any means to remove devitalized tissue, maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings, appropriate off-loading, and necessary treatment to resolve any infection that might be present. 

Documentation must support no measurable sign of healing for 30 days prior to starting HBO including wound measurements prior to the initiation of HBO and wound measurements after HBO. Continued treatment with HBO therapy is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment.

The topical application of oxygen does not meet the definition of HBO therapy. Continuous Diffusion of Oxygen Therapy (CDO) also referenced as Topical Application of Oxygen and Topical Oxygen Therapy (TOT) for the treatment of wounds is not covered. Its clinical efficacy has not been established. No reimbursement may be made for the topical application of oxygen for wounds.

Covered CPT and HCPCS Codes

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 (e.g., 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 modifier 25 must be applied to the E & M service. 
• Documentation must reflect the necessity, as well as a description of services provided. 
• This code reflects a per session descriptor, therefore, regardless of the time, HBO therapy is performed (e.g., 1 hour, 2 hours) during each session, each unit billed equals one session.

HCPCS Code G0277

• Hospitals will bill HCPCS code G0277 for hyperbaric oxygen (HBO) therapy. This code is billed in 30 mins increments. Treatment time starts at beginning of chamber pressurization and ends when chamber depressurization is finished.
• Medically Unlikely Edits (MUE) apply - five units per date of service based on clinical benchmarks. Providers can appeal a denial if the date of service exceeds five units. Documentation submitted must support units of service in excess were reasonable and necessary.

Additional Billing Tips

• E&M services integral to HBO therapy include, but are not limited to, updating history and physical, examining patient, reviewing laboratory results and vital signs with special attention to pulmonary function, blood pressure, and blood sugar levels, clearing a patient for the procedure, monitoring and/or assisting with patient positioning, evaluating and treating patient for barotrauma and other complications, prescribing appropriate medications, etc.
• Physician may report E&M services performed on the same date of service of HBO with modifier 25, if a physician performs unrelated, significant, and separately identifiable services.
• Medicare coverage of topical oxygen for treatment of chronic wounds will be determined by local Medicare Administrative Contractors (MACs).
• NCD lists non-covered items and services, such as cutaneous, decubitus, and stasis ulcers. 
• Applicable ‘Place of Service’ (POS) codes:
  • 11: Office
  • 19: Off-campus outpatient hospital
  • 21: Inpatient hospital
  • 22: On-campus outpatient hospital
  • 49: Independent clinic

Billing and coding for wound care can be quite demanding, it may not make much economic and strategic sense to run these operations in-house. In addition, the industry is changing at an unprecedented rate, making it difficult for medical practices to keep up with the ever-changing rules and regulations in wound care medical billing and coding.

Medical Billers and Coders (MBC) provides wound care medical billing and coding services that ensure on-time and accurate billing. To know more about our wound care billing services, you can contact us at 888-357-3226/ info@medicalbillersandcoders.com