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Diabetic Foot Ulcers; criteria for "diabetic"
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12/1/2012 at 7:04:32 PM GMT
Posts: 16
Diabetic Foot Ulcers; criteria for "diabetic"

I have a patient who says she is diabetic.  But the problem is that she has a normal a1c and is not on any medications.  Do I take her on her word?  

Weight loss is a know cure for diabetes, i.e. gastric bypass etc.  Likewise, steroid induced diabetes or gestational diabetes often resolves, so diabetes can in fact be a temporary state.

 Can we take her at her word and treat her wound as a diabetic wound?

Should we do an oral glucoe tolerance test and determine if she is diabetic based on current guidelines?  (my preference) as we have no testing supporting her claim.

I believe HBO is likely to help her wound, however, I can see a denial of payment due to "not being diabetic" if I simply take it on her word, in light of her not being on any meds and having a normal a1c.

 


 




12/27/2012 at 3:59:22 PM GMT
Posts: 16

In New Jersey we need to show the insurance that the patient is a diabetic, their wound(s) have failed a stardard course of wound care longer than 30 days and the wound is classified as a Wagner Grade III or higher.  If they do not fit this criteria, they do not receive treatment.  Also, they will need to undergo some sort of vascular intervention, ie: TCOM to show that they have adequate blood flow.

 

I would not go by their word.  If their a1c is normal, you can bet the insurance will not approve of HBO.



2/15/2013 at 5:25:00 PM GMT
Posts: 9
We treated a patient using the diabetic foot wound diagnosis who was no longer diabetic post pancreatic transplant. This patient did not take any diabetes medications and had a normal a1c. The patient had been diabetic for many years and our physician argued the vessel damage from the diabetes still existed and, therefore, hyperbaric therapy was warranted. We had documentation of his diabetic history.


Last edited Friday, February 15, 2013
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