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Tips to Boost Your Documentation Process: Guidelines for Home Oxygen for Medicare Patients

Posted on Wed, Jan 14, 2015
Tips to Boost Your Documentation Process: Guidelines for Home Oxygen for Medicare Patients

Medicare is actively enforcing the following guidelines when documenting the need for home oxygen.

The physician must clearly document the need for home oxygen in the medical record in order for it to be covered by Medicare.

The following criteria must be met and documented by a physician to qualify for home oxygen:
Pa 02 ≤ 55mmHg

OR

Sa02 ≤ 88 percent while awake, asleep and at rest

If the above criteria are met with exertion, three tests are required:
1.  On room air, at rest
2.  On room air, during exertion
3.  On oxygen, during exertion

If the test is done during sleep, it must show at least five minutes (not continuous) of SaO2 ≤ 88 percent or Pa02 ≤ 55 mmHg.

However, if the patient has severe lung disease or hypoxia-related symptoms that might be expected to improve with oxygen therapy, this is acceptable for Medicare coverage. Values must be recorded within 48 hours of discharge from the hospital. The physician must complete the Certificate of Medical Necessity – Oxygen DME form CMS-484.

ABOUT THE AUTHOR
Dr. Timothy Brundage is a hospitalist for EmCare at St. Petersburg General Hospital in St. Petersburg, FL. Dr. Brundage earned his bachelor’s degree in chemistry and molecular biology at the University of Michigan, his M.D. at the Wayne State University School of Medicine and completed his residency in internal medicine at the University of South Florida College of Medicine. Subscribe to Dr. Brundage’s weekly documentation tips, or ask him about specific documentation issues, by emailing him at DrBrundage@gmail.com.

 

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