[abstract] REIMBURSEMENT CONSIDERATIONS FOR A WOUND HEALING CENTER THAT UTILIZES HYPERBARIC OXYGEN THERAPY

Abstract

Objective: To advance the understanding of principles utilized in the coding, billing, and reimbursement practices for a Comprehensive Wound Healing Center (CWHC). Overview: Payment policies for wound healing centers that employ treatment modalities such as hyperbaric oxygen therapy are subject to national rules as well as an interpretation of those rules by local Fiscal Intermediaries and/or Carriers. A review of the Medicare reimbursement system, including the Outpatient Prospective Payment System (OPPS), serves as the focus for this presentation. Coding and billing practices will be discussed as they relate specifically to a CWHC. Discussion will incorporate the appropriate use of ICD-9 codes, HCPCS/CPT codes, and modifiers. In addition, there will be reimbursement updates specific to hyperbaric oxygen therapy that consists of increased payments to hospitals and physicians and coverage for a "new" indication. Also included are revisions to physician supervision and credentialing requirements for hyperbaric oxygen treatments. Conclusion: Facilities face daunting challenges when coding, billing, and attempting to obtain reimbursement for the services of a CWHC. They must employ current practices and strategies in order to optimize reimbursement.