Article Detail - JD DME
RETIRED - Oxygen Testing and Documentation in the Medical Records
Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.
Original Effective Date: 04/01/2000
Revision Effective Date: 11/01/2013
Region D DMERC periodically conducts audits on claims submitted by various suppliers of home oxygen and related equipment for which medical records from the referring physician may be requested. Audit findings show that many oxygen Certificates of Medical Necessity include only an oxygen saturation taken by pulse oximetry, while the medical records also contain results of one or more arterial blood gas studies (ABGs). The Coverage Issues Manual (CIM) 60-4 states, "When the arterial blood gas and oximetry studies are both used to document the need for home oxygen therapy and the results are conflicting, the arterial blood gas study is the preferred source of documenting medical need." In addition the most recent test taken on or before the certification date must be entered on the CMN.
In this situation, if documentation in the medical record contains the result of an ABG performed on the same day as the oximetry saturation recorded on the CMN and they are the most recent tests taken on or before the certification date on the CMN, the ABG will be used to determine oxygen coverage for that certification. If the ABG does not substantiate the need for oxygen the claim(s) will be denied as not reasonable and necessary. If the tests are not performed on the same day, the most recent test will be used in the determination for oxygen coverage.
Last Updated Thu, 10 Jan 2019 12:43:06 +0000