Lisa,
Quite frankly this comes down to a coverage issue and what is the patient's clinical problems. If a patient has significant vascular disease and had had an "acute vascular event, then going down the acute arterial thrombosis pathway would be appropriate as these patients cannot wait 30 days, if they are diabetic. DFU vs chronic refractory osteo is a different story. The Wagner scale does not take into account acute vs chronic osteo, it's just osteomyelitis. So for a DFU, to qualify for HBO you would MUST show that you have done "standard care", the patient is a Wagner III or higher AND (per Medicare and most commercial carriers), there are no measurable signs of healing for 30 days, then on 31 you could consider HBO. For chronic osteo, you would need to show that the patient had acute osteomyelitis that was treated appropriately (debridement, IV/po Abx) but it did not resolve after some time frame (typically 4-6 weeks). So now you have chronic osteomyelitis, and you would typically do more debridement, abx, and could add HBO adjuctively. So, these are really 3 separate pathways you can go down and your patient may qualify for HBO in more than one way. It depends on how you tell the story. So if their arterial disease is bad enough and you feel this they have had an "acute" arterial event, then you could consider HBO at an earlier time frame than going down the DFU pathway. Although, it is important to remember that Medicare typically expects Acute arterial patients to be "In-patient" to start with. Finally, for Medicare patients, the HBO NCD specifically excludes chronic arterial ischemia from being reimbursed. Would HBO work in the situation you described, probably so but in real life it is going to be very difficult from a reimbursement standpoint.