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HBO Physician Orders Overview

HBO Physician Orders Overview

HBO Physician Orders Overview



Hyperbaric oxygen therapy (HBOT) is a modality in which the entire body is exposed to oxygen (100%) under increased atmospheric pressure (>1 atm).  This is conducted in either a monoplace chamber, dual place chamber, or multiplace chamber.  

What is a Physician Order Set?

Medicare, Medicaid and federally funded payers have specific coverage and documentation requirements for HBOT. An order set is a grouping of orders, used to standardize and expedite the ordering process. The Physician Order Sets establish guidelines outlining the documentation required to support hyperbaric oxygen therapy in accordance with Medicare, Medicaid and other federally funded payer guidelines.  

When is a Physician Order needed?

Physician Orders are required prior to the initiation of Hyperbaric oxygen therapy.  The order should be for a single treatment. The documentation presented in the clinical record must provide an accurate description and diagnosis of the medical condition supporting that the use of HBOT is reasonable and medically necessary.

What should a Physician Order include?

The physician order for Hyperbaric Oxygen Therapy must include but is not limited to the following:

  • Hyperbaric diagnosis and Treatment protocol.
  • Specific pre-HBOT diagnostics necessary
  • Date on which HBOT is to begin
  • Treatment Pressure (depth) and oxygen breathing period
  • Total treatment time
  • Air breaks – when indicated or per treatment protocol
  • TCOM’s (as appropriate to patient condition)
  • Total estimated number of treatment sessions

At a minimum, the following elements should be provided on the physician order form as well:

  • Signature,  date and time of the order.
  • The patient’s name, date of birth and medical record/account number.  
  • The name of physician or authorized individual ordering hyperbaric oxygen services.
  • Authentication of physician or authorized individual ordering hyperbaric oxygen services.

Orders from Physicians that are not institutionally credentialed as a qualified Hyperbaric provider will not be accepted


Indications Sample Physician Order

Acute Carbon Monoxide Poisoning

Acute Exceptional Blood Loss Anemia

 Acute Peripheral Arterial Insufficiency

Acute Traumatic Peripheral Ischemia

Cerebral Arterial Gas Embolism - Initial Treatment

Cerebral Arterial Gas Embolism - Follow up

Chronic Refractory Osteomyelitis

Clostridial Myonecrosis (Gas Gangrene)

Compromised Skin Graft/Flap, Digit/limb Replantation

Crush Injuries and Suturing of Severed Limbs

Cyanide Poisoning

Decompression Illness - Initial Treatment

Decompression Illness - Follow up

Diabetic Ulcer - Lower Extremity

Idiopathic Sudden Sensorineural Hearing Loss

Pyogenic and Invasive Fungal Intracranial Abscess (includes Actinomycosis)

Necrotizing Soft Tissue Infections and Fournier's Gangrene

Osteoradionecrosis Mandibular

Soft Tissue Radiation Injury

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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.
Topic 45 Version 1.0