Undersea & Hyperbaric Medical Society

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A recent directive by one Medicare fiscal intermediary has caused some confusion within the hyperbaric community. Here is the background on the directive and how it should be applied:

As many of you appreciate, Medicare is federal program. Coverage policies directly generated by the federal program (and in the context of this memo I am addressing hyperbaric oxygen therapy) are called National Coverage Determinations (NCD's). Medicare's program is administered by regional and national intermediaries. These FI's can make some changes to the NCD's as they produce their own Local Coverage Determinations (LCD's). Some will strictly abide by the NCD, others will make changes, the most common being the attendance requirement of the hyperbaric physician.

Now the recent issue: In a revised version of an LCD, in December 2007, National Government Services, a Medicare FI with broad national coverage, added a new indication for HBO therapy. This new indication only applies, however to regions where National Government Services acts as the FI, ie an LCD not a NCD. Found in the last sentence of Section 5 (Crush Injury, Acute Ischemia) is the statement: ‘Arterial insufficiency ulcers may be treated with HBO therapy if they are persistent after reconstructive surgery has restored large vessel function’.  However, NGS failed to add the arterial ulcer ICD-9 diagnosis code to their LCD.

As providers bill under a diagnosis code (and not its descriptor) any claims for the treatment of arterial insufficiency ulcers with HBO would be (and were) denied because the correct ICD-9 code providers did use (440.23) was not a code that represented medical necessity.

I therefore wrote to the medical director of NGS (attached link), pointed out this oversight and requested that ICD-9 Code 440.23 be added to their LCD list of covered diagnoses. A reply from the director (attached link) confirmed the shortcoming and agreed to add the code.

What is circulating now is an update to NGS’s LCD for hyperbaric oxygen therapy noting the addition of the arterial insufficiency ulcer code.

               
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