Great question, Lisa!

The large majority of your question is simply answered. NO.

Now for the picky details. If your insurance covers DFU, Wagner 3 or higher, having failed 30 days of ‘standard’ wound care, whatever they define that term to be, then possibly under a DFU diagnosis.

If you have an osteomyelitis, following wound care, appropriate surgical debridement, then appropriate antibiotics (4-6 weeks), then the osteo returns … possibly covered.

However, the way that you phrased the question, the answer will be categorically, NO.

Limb salvage is not an acceptable diagnosis for HBOT that insurance companies approve.

I hope the message is coming through … it all depends on the story you tell in your documentation, and it starts with an appropriate, approved indication for HBOT.

I hope this helps.

gene

Others feel free to comment.

Lisa, you have a complicated patient with end stage arterial occlusion. You have described several diagnoses … and appear to be fishing for something that HBOT can tag. (I don’t mean to be condescending, it just happens.) Your insurance company will not like you trying to justify HBOT by throwing several diagnoses to them. Here’s how I would proceed.

To me, you have described a DFU with infection (the quintessential diagnosis of a Wagner 3 DFU). You need to examine the insurance company’s DFU criteria. Those items will be the foundation of any audit … could happen … and result in denials after the fact.

Stick to one diagnosis. Document that you tried standard (and emphasize standard) wound care for more than 30 days, then TCOM values … room air, surface O2 and in chamber if you have it. Just move down the insurance company requirements, and have your doctor/NP/PA document those items. This just helps the insurance company auditors … those are the items that they require.

I would document that this DFU has ‘infected bone’ at the base of the ulcer. Yes, it is technically osteomyelitis, but the story we are telling is a DFU with infection … Don’t use osteomyelitis as a term.

You can comment on the end stage vascular disease as part of the TCOM interpretation, but do not dwell on it. As an aside, if you have a cardiologist or radiologist interested is limb salvage, please make sure to get the to squirt this patient and see if there are any stent possibilities for this patient.

All the best!

gene