Hi, Sarah ... thanks for the question. Let's clear up a couple of things before the "long-winded" answer. First, this condition (should you search the literature, and I recommend that you look at PubMed) is called BRONJ (Bisphosphonate Related OsteoNecrosis of the Jaw).

You are headed in the right direction, thinking about aseptic necrosis ... close, but no cigar. This is more like an osteomyelitis, but it has some of the characteristics of aseptic necrosis.

You've given the basis of treatment right there. If your physician documents as well as you have given in this thumbnail, you are well on your way.

For documentation, I would describe the relationship to the bisphosphonate, just as you have. Then, I would tell the story of refractory osteomyelitis ... as you did above. This patient has an osteo picture in the maxillary ridge, and has been treated with surgical debridement and several adequate courses of antibiotics (I think it would help if you had a positive bone culture ... but you can state that bone was sent to culture and had no growth) ...

Then, I would code this as a chronic refractory osteomyelitis and get your approval.

When you look this up for HBOT, the author is Freiberger. There were several papers from Duke on this topic with long-term followup.

Good luck!

Thank you for the rapid response. I was thinking we could go down the chronic refractory osteomyelitis route. The patient is also completing an MRI, so I anticipate we will have this for support.

Thanks again!
Sarah, RN