Medicare Oxygen Checklist
- Progress Notes/Face to Face:
A plan of careincluding a historical respiratory assessment, documentation that patient has been compliant with their medications and deemed ineffective prior to ordering oxygen therapy.
- Oxygen Testing:
88% on room air at restif the patient is below 88% on R/A @ rest- that is all the testing needed.- If testing the patient on exertion a 3-part test is necessary:
- O2 sats on room air
- O2 sats during exertion on room air
- O2 sats during exertion with oxygen applied (include the liter flow)
- Exertion text example: "Patient will require home o2 due to hypoxia during exertion... o2 sats 94% on R/A @ rest, 86% R/A w/ exertion, 92% w/ exertion 2LPM o2 applied. Patient will require long term home o2
- If testing the patient on exertion a 3-part test is necessary:
- Reminders:
- Patients prescribed oxygen "PRN" or "as needed" do not meet coverage criteria and will not be covered for home oxygen therapy.
- Medicare only considers long term oxygen therapy for payment; short term therapy for an acute condition is not a covered benefit.
CPAP/BIPAP Documentation Checklist
- Patient demographics
- Face to face chart notes -----prior to sleep study
- PSG,Split Study or HST (also titrated study if ordering BIPAP)
- Rx with description of items ordered
- **IF AHI is less than 15 the patient must also have one of the following diagnosis indicated in their progress notes to qualify: excessive daytime sleepiness, hypertension, impaired cognition, mood disorders, insomnia, ischemic heart disease, history of stroke
- If ordering home sleep test, include home sleep test instructions
For ordering BIPAP ALL of the above applies and the following is also required:
- A Cpap has been tried and proven ineffective based on a therapeutic trial conducted in either facility or in a home setting
- Ineffective is defined as documented failure to meet therapeutic goals using a Cpap during the titration portion of a facility-based study or during home use (i.e. proper mask fitting and selection with appropriate pressure settings)
- A NEW Face to Face is required for Bipap if the patient has used a Cpap for more than 3 months