Billing

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Friday, October 31, 2003

Rules of oxygen testing
with Karen Moore

Q. Is it true that multiple test results need to be obtained in order to qualify a patient for home oxygen when the test is done during exercise? If so can you explain these test requirements?

A. To qualify a Medicare patient for home oxygen when the test is performed with exercise, there must be documentation that the oxygen improves the hypoxemia that is present during exercise while the patient is breathing room air. Normally, this documentation would consist of testing the patient three separate times under different conditions. The first test should be performed with the patient breathing room air and at rest. The second test should be performed with the patient breathing room air with exercise, and the third test performed while the patient is breathing oxygen with exercise. To qualify when oxygen saturations are obtained in the above scenario, the patient’s oxygen saturation that was taken on room air at rest would have to be greater than 89%, while the test taken on room air with exercise would need to be equal to or less than 89% and the third test which would be performed while the patient is on oxygen with exercise shows that the oxygen improves the hypoxemia. (Note: Arterial P02 testing can also be used.) The diagnosis required would depend on whether the test value falls into Group I or Group II criteria.

The reported test result is the one taken while the patient was breathing room air with exercise. However, all three test results should be in the medical records.

Karen Moore is a v.p. of Ancor Healthcare Consulting. Contact her at 954-757-3121.

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