I have been posting information from the MAC websites about audits and required documentation, particularly for HBOT. The Palmetto MAC website has detailed information about certain specific HBOT indications if you sufficiently medicated to manage the intense frustration of the cute website. Using the link below, you hover over the indication and can briefly see the details. Forget about getting the information to stay on the screen long enough to write them down.
I laboriously pasted screen shots of the information on failing flaps. There are some fascinating things. Firstly, even though the specific covered codes for HBOT do not include the codes for failing flaps (the cross walk to ICD10 only included failing skin grafts), failing flaps are clearly listed as an indication for HBOT. I’d say that’s good. And notice this — they cover “preparation of a previously failed site”. There are caveats to that indication, but I haven’t seen verbiage like this for more than 20 years since the good old days when we treated wounds as a “preparation for grafting.” (I wonder what ICD10 code to use for that?).
Note the specific exclusions to coverage for failing grafts/flaps which include: HBOT for approximation of surgical skin edges, a “non healing stump” (unless it meets the specific criteria stated), and using placement of a “skin sub” as a procedure that justifies HBOT for a “skin graft”.
Palmetto is the MAC for:
- Region J: Alabama, Georgia, Tennessee (Region J)
- Region M: North Carolina, South Carolina, Virginia, West Virginia (excludes Part B for the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)
Home Health and Hospice for: Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Texas