Health Information Management

Q/A: Changes to HBO therapy billing

APCs Insider, January 7, 2011

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Q: Did CMS provide any new updates for hyperbaric oxygen (HBO) therapy services for 2011?

A: Based on the 2011 OPPS final rule, HCPCS code C1300 (hyperbaric oxygen under pressure, full body chamber, per 30 minute interval), which falls within APC 0659 (hyperbaric oxygen therapy) with a national unadjusted payment rate of $104.99, did not change.

However, CMS told providers that claims reporting only a single occurrence of the code were anomalies. CMS noted that this was either because the claim reflected a terminated session or because the service was incorrectly coded with a single unit.

Therefore, we urge providers to audit their claims to ensure that:

• Documentation of the service reflects the time of the service
• The units reported reflect the documentation
• The units are reported and submitted correctly based on the actual service time and not defaulted to one because no time increment was documented

Review CMS’ National Coverage Determination for Hyperbaric Oxygen (HBO) Therapy 20.29 for more information.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.



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