In the attached document, Hart Medical has outlined an additional step to provide supplemental oxygen for our patients.
As this is a Medicare guideline, I suspect all other DME providers and insurance companies will adopt or have adopted these changes as well.
To prescribe oxygen the patient needs to:
- Have an oxygen saturation ≤ 88% (or ≤ 89% with any of the following):
- Dependent edema suggesting congestive heart failure (-OR-)
- Pulmonary hypertension or cor pulmonale, determined by measurement of pulmonary artery pressure, gated blood pool scan, echocardiogram, or “P” pulmonale on EKG (P wave greater than 3 mm in standard leads II, III, or AVF) (-OR-)
- Erythrocythemia with a hematocrit greater than 56%
- Have an oxygen saturation ≤ 88% on room air with exercise
- Have an oxygen saturation ≤ 88% during sleep for at least 5 minutes (does not have to be continuous)
In addition to the oxygen prescribing criteria, the PRESCRIBING PROVIDER will now need to do one of the following:
- Mention the evidence of oxygen saturation test results in the chart notes (-OR-)
- Add a new chart note regarding the evidence of oxygen saturation test results (-OR-)
- Co-sign the actual oxygen saturation test results
Since all of our walk oxygen tests and 6 minute walk tests are signed by the PFT fellow and the K17 OPD rounder (or Mike Lazar on Fridays), choice #3 will often not be applicable.
So, to be compliant with the new Medicare requirements:
- Please make sure that you comment directly on the oxygen saturation test in your progress note (i.e., when you see the patient in clinic) -OR-generate a new note in Epic.
- One of these notes should coincide to when you generate an oxygen prescription in Epic.
- You note should also include that “the patient’s medical condition will benefit from oxygen”.