Article Detail - JA DME

National DME MAC Education

The Oxygen and Oxygen Equipment Local Coverage Determination (LCD) (L33797) requires that "The treating practitioner has … evaluated the results of a qualifying blood gas study performed at the time of need." The DME MACs have received many inquiries regarding how this information may be documented to satisfy the requirement.

As a reminder, it is required that the medical record documentation include the results of the qualifying blood gas study performed by a treating practitioner, qualified provider, or supplier of laboratory services.

In situations where the blood gas study was not conducted directly by the treating practitioner, documentation to support that the treating practitioner evaluated the qualifying blood gas study results may include (not all inclusive):

• The incorporation of a copy of the blood gas study or the results from the blood gas study into the treating practitioner's chart notes; or,
• Treating practitioner documentation in which he/she references the evaluation of the blood gas study performed on a specific date; or,
• The treating practitioner's signature on a copy of the blood gas study results. The treating practitioner's signature indicates he/she evaluated the results; or,
• Inclusion of either of the following on the treating practitioner's standard written order (SWO) for home oxygen therapy: blood gas study results or reference to the evaluation of the blood gas study performed on a specific date.
  • Note: While inclusion, of either of the above, on the treating practitioner's SWO may support that the treating practitioner evaluated the blood gas study results, as previously noted the results of the blood gas study must also be documented in the medical record documentation rendered by a practitioner, qualified provider, or supplier of laboratory services who performed the study.

When the treating practitioner directly conducts the qualifying blood gas study, the treating practitioner's documentation of the blood gas study results satisfies, both, the requirement that the medical record documentation include the results of the study and that the treating practitioner evaluate the results.

The DME MACs strongly encourage suppliers to obtain medical records upfront to confirm sufficient documentation exists to support the coverage criteria are met prior to dispensing the equipment or billing the claim to Medicare.