The following indications are approved uses of hyperbaric oxygen therapy as defined by the Hyperbaric Oxygen Therapy Committee, Medicare and the FDA. The Committee Report can be purchased directly through the UHMS.
Medicare Approved Indications
Description
|
Dx Code
|
| Abdominal Actinomycotic infections | 039.2 |
| Actinomycotic infections of other specified sites | 039.8 |
| Actinomycotic infections of other unspecified sites | 039.9 |
| Air embolism | 958.0 |
| Air embolism, due to complication of medical care | 999.1 |
| Arterial embolism and thrombosis of Iliac artery | 444.81 |
| Arterial embolism and thrombosis of arteries of the lower extremity | 444.22 |
| Arterial embolism and thrombosis of arteries of the upper extremity | 444.21 |
| Aseptic necrosis of bone, head and neck of femur | 733.42 |
| Aseptic necrosis of bone, head of humerus | 733.41 |
| Aseptic necrosis of bone, Medial femoral condyle | 733.43 |
| Aseptic necrosis of bone, other | 733.49 |
| Aseptic necrosis of bone, Talus | 733.44 |
| Caisson disease (Bends, compressed-air disease, decompression sickness, divers' palsy or paralysis | 933.3 |
| Cervicofacial Actinomycotic infectons | 039.3 |
| Chronic Osteomyelitis, ankle and foot | 730.17 |
| Chronic Osteomyelitis, forearm | 730.13 |
| Chronic Osteomyelitis, hand | 730.14 |
| Chronic Osteomyelitis, lower leg | 730.16 |
| Chronic Osteomyelitis, multiple sites | 730.19 |
| Chronic Osteomyelitis, other specified sites | 730.18 |
| Chronic Osteomyelitis, pelvic region and thigh | 730.15 |
| Chronic Osteomyelitis, shoulder region | 730.11 |
| Chronic Osteomyelitis, site unspecified | 730.10 |
| Chronic Osteomyelitis, upper arm | 730.12 |
| Complications of reattached extremity or body part, unspecified extremity | 996.90 |
| Complications of reattached finger(s) | 996.93 |
| Complication of reattached foot and toe(s) | 996.95 |
| Complications of reattached forearm | 996.91 |
| Complications of reattached hand | 996.92 |
| Complication of reattached lower extremity, other and unspecified | 996.96 |
| Complication of reattached other specifed body part | 996.99 |
| Complications of reattached upper extremity, other and unspecified | 996.94 |
| Crushing injury to ankle | 928.21 |
| Crushing injury to Axillary region | 927.02 |
| Crushing injury to elbow | 927.11 |
| Crushing injury to foot | 928.20 |
| Crushing injury to forearm | 927.10 |
| Crushing injury to hands | 927.20 |
| Crushing injury to hip | 928.01 |
| Crushing injury to knee | 928.11 |
| Crushing injury to lower leg | 928.10 |
| Crushing injury to multiple sites of lower limb | 928.8 |
| Crushing injury to multiple sites (upper extremeties) | 927.09 |
| Crushing injury to multipe sites, not elsewhere classified | 929.0 |
| Crushing injury to multiple sites of upper limb | 927.8 |
| Crushing injury to Scapular region | 927.01 |
| Crushing injury to shoulder region | 927.00 |
| Crushing injury to thigh | 928.00 |
| Crushing injury to toe(s) | 928.3 |
| Crushing injury to unspecfied site (lower extremeties) | 928.9 |
| Crushing injury to unspecified site (upper extremeties) | 927.9 |
| Crushing injury to upper arm | 927.03 |
| Crushing injury to wrist | 927.21 |
| Cutaneous Actinomycotic infections (Erythrasma-Trichomycosis axillaris) | 039.0 |
| Diabetes with peripheral circulatorty disorders(use additional code to identify manifestation -gangrene 785.4, peripheral angiopathy 443.81 | 250.70 |
| Diabetes with other specified manifestations (use additional code to identify manifestation any associated ulcerations 707.10-707.19 | 250.83 |
| Diseases of the jaws- Cherubism, Fibrous dysplasia, Latent bone cyst, Osteoradionecrosis, Unilateral condylar hyperplasia or hypoplasia of mandible | 526.89 |
| Effects of air pressure, other and unspecified effects of high altitude | 993.2 |
| Effects of radiation, unspecified | 990 |
Gas gangrene (Gas bacillus infection or gangrene, Infection by Clostridium, histolyticum, oedematiens, perfringens, spticum, sordellii, malignant edema, myonecrosis clostridial, myositis clostridial)
| 040.0 |
| Injury to Axillary artery | 903.01 |
| Injury to Brachial blood vessels | 903.1 |
| Injury to common femoral artery | 904.0 |
| Injury to Iliac artery | 902.53 |
| Injury to Popliteal artery | 904.41 |
| Late effects of radiation | 909.2 |
| Madura foot Acinomycotic infections | 039.4 |
| Mechanical complication due to graft of other tissue, not elsewhere classified (skin graft failure or rejection, excludes failure of artificial skin graft, failure of decellularized allodermis, sloughing of temporary skin allografts or xenografts (pigskin) | 996.52 |
| Necrotizing fascititis | 728.86 |
| Pulmunary Actinomycotic infections | 039.1 |
| Pyoderma gangrenosum | 686.01 |
| Pyoderma, other | 686.09 |
| Toxic effect of carbon monoxide | 986 |
| Toxic effect of Hydrocyanic acid and cyanides | 989.0 |
| Toxic effect of Hydrocyanic acid gas | 987.7 |
| Ulcer of ankle (to be used with 250.83 as an additional code) | 707.13 |
| Ulcer of calf (to be used with 250.83 as an additional code) | 707.12 |
| Ulcer of lower limb, unspecified (to be used with 250.83 as additional code) | 707.10 |
| Ulcer of heel and midfoot (to be used with 250.83 as an additional code) | 707.14 |
| Ulcer of other part of foot (toes) (to be used with 250.83 as an additional code) | 707.15 |
| Ulcer of other part of lower limb (to be used with 250.83 as an additonal code) | 707.19 |
| Ulcer of thigh,(to be used with 250.83 as additional code) | 707.11 |
| Unspecified effect of air pressure | 993.9 |
Sumber : ORCCA Hyperbaric Oxygen Delray Beach, Florida
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