Wiki Denial HELP Hyperbaric Oxygen 99183

bubnash

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I have received a denial for a patient DOS 5/7/18 for HBO 99183 dual DX of 170.238, L97.812 - these codes are on the NCD 20.29 - I must to interperting incorrectly - any suggestions.
The patient does not have diabetes. He had his right toes amputated because of servere PAD

Thanks
Bobbie
 
Hope this helps. This is from medicare

Acute carbon monoxide intoxication,
Decompression illness,
Gas embolism,
Gas gangrene,
Acute traumatic peripheral ischemia. HBO therapy is a valuable adjunctive treatment to be used in combination with accepted standard therapeutic measures when loss of function, limb, or life is threatened.
Crush injuries and suturing of severed limbs. As in the previous conditions, HBO therapy would be an adjunctive treatment when loss of function, limb, or life is threatened.
Progressive necrotizing infections (necrotizing fasciitis),
Acute peripheral arterial insufficiency,
Preparation and preservation of compromised skin grafts (not for primary management of wounds),
Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management,
Osteoradionecrosis as an adjunct to conventional treatment,
Soft tissue radionecrosis as an adjunct to conventional treatment,
Cyanide poisoning,
Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment,
Diabetic wounds of the lower extremities in patients who meet the following three criteria:
Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes;
Patient has a wound classified as Wagner grade III or higher; and
Patient has failed an adequate course of standard wound therapy.
 
You are correct that those two dx codes are listed in NCD20.29; however, they are assigned to the DWLE (Diabetic Wounds of the Lower Extremity) indication. Since the patient does not have diabetes, the payor (assuming this was Medicare because you referenced the NCD) was looking for a diabetes code to go with the other two codes. Not having seen the full documentation for this patient, does the provider indicate why the patient was being treated with HBOT - - and does it match one of the approved indications?

I have an article specifically dedicated to assigning dx codes for HBOT premiering in the October issue of Healthcare Business Monthly. Hopefully, this will provide you with further guidance.
 
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