Monthly Hyperbaric Compliance Series
May 2008
Acute Peripheral Arterial Insufficiency
This is another example of an indication for HBO therapy that is mis-applied. It has already been the subject of punitive action by Medicare. In order to guide clinical practice compliance with the urgent intent of this indication, one Medicare Fiscal intermediary has incorporated the following qualifying language:
"This is an emergent condition requiring the continuous presence of the physician beside the chamber’"(1)
The issue appears to be one of some providers using this indication in order to treat chronic wounds of the lower extremity. Arguments such as an ‘acute exacerbation of a chronic wound’ or ‘wound persistence following a lower extremity flow augmentation procedure’ have been applied. Neither of these arguments meet the ‘medically necessary’ intent of this indication.
The intent of this indication centers around the expectation that an acute intravascular event has occurred and secondary to arterial embolism and thrombosis. HBO therapy would presumably be employed urgently in order to support acutely threatened tissues and limit or eliminate the likelihood of any tissue loss. One etiological factor that could produce an acute peripheral arterial insufficiency is plaque showers following an endarterectomy procedure.
External force injuries that disrupt arterial inflow and threaten tissues are classified as either acute traumatic peripheral ischemia, crush injury or compartment syndrome and coded elsewhere, as appropriate. They do not meet the necessary definition of an acute peripheral arterial insufficiency.
(1) Trailblazer Health Enterprises,; LCD Hyperbaric Oxygen Therapy – M – 15A – R5:11/2006
Previous Monthly Compliance Series: