Home Oxygen Therapy
January 22nd, 2019 - Raquel Shumway
Medicare will cover certain oxygen items/equipment for Home use, provided there is proper documentation showing that they are both reasonable and necessary in accordance with local MAC policies (LCDs). Here are a few of the highlights regarding those items and the requirements as found in Medicare's MLN Home Oxygen Therapy Booklet which also includes additional information.
In order for these items to be covered, Medicare requires that they are:
- Eligible for a defined Medicare benefit category
- Reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member
- Ordered by providers and furnished by suppliers who are enrolled in the Medicare Program and
- Meet all other applicable Medicare statutory and regulatory requirements
To be considered reasonable and necessary these items must meet ALL of the required criteria.
Initial Certifications Tables 1-3
Patient’s blood gas study values must meet one of these criteria: (either an arterial blood gas or an oximetry test)
Table 1: Group 1 Criteria
Table 2: Group 2 Criteria
Medicare will deny claim as not reasonable and not necessary if the only qualifying blood gas study is performed during sleep.
Table 3: Group 3 Criteria:
May be covered when patients are enrolled in a CMS approved clinical trial.
Home Oxygen Therapy also includes specific requirements for providers, and suppliers of DME on the following topics (Click on each link below for further information):
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
COVID Vaccine Coding Changes as of November 1, 2023October 26th, 2023 - Wyn StaheliCOVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M ServicesOctober 11th, 2023 - Wyn Staheli2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?October 10th, 2023 - Aimee WilcoxWhen EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.
Accurately Reporting Signs and Symptoms with ICD-10-CM CodesOctober 5th, 2023 - Aimee WilcoxCoders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.
The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin ResistanceSeptember 19th, 2023 - Aimee WilcoxDiabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.
Documenting and Reporting Postoperative VisitsSeptember 12th, 2023 - Aimee WilcoxSometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period?
Understanding Gastroesophageal Reflux Disease and ICD-10-CM CodingAugust 22nd, 2023 - Aimee WilcoxGastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.
