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Physician agreement
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1/29/2013 at 9:17:12 AM GMT
Posts: 4
Physician agreement

Do any of you have guidelines for your centers on physician agreement for diving indications?  One physician wants to dive a pt for chronic osteo in an elbow wound that has been open many month but another thinks pt should be evaluated by orthopedic surgery for nonviable bone first.

Do you require all physicians to agree to diving indications?  How do your physicians communicate, or do they, prior to starting a new pt diving?

1/29/2013 at 2:32:22 PM GMT
Posts: 15
Chronic Osteomyelitis

The treatment for chronic osteomyelitis is the use of antibiotics with adjunctive hyperbaric oxygen therapy (HBOT) with surgical debridement as needed.  All of my patients are usually on antibiotics when I start HBOT.  I usually follow with the physician who is managing the wound to decide on the need for debridement.  I do not withold HBOT until this is decided.  I am sure you will find physicians who feel differently.  Both options are acceptable.  Not sure I helped.


2/2/2013 at 1:04:50 PM GMT
Posts: 4

Thank you for your input.

Do you work with other physicians with HBO?  If so, do you communicate about pts you approve for diving prior to the other physician seeing the pt for the first time?  Letting someone know pt's risk factors and potential problems etc. before they meet at bedside.

I am trying to improve our pre-diving communication and am interested in how others do it.

2/25/2013 at 5:47:34 AM GMT
Posts: 16

Do you have a medical director?  This is the medical director's role.  If you do not have a medical director, then you need to make sure all of your doctor's are at least educated on the requirements of your payors and especially the CMS LCD or NCD that you are covered by.  If you don't have a medical director, perhaps you have a contracted group that staffs your unit (healogics, paragon, etc?)  In any case, your doctors having varying definitions of what is an indication for treatment is putting themselves as well as your clinic at risk for audits, denials, and demand for return of reimbursement.


P Benson MD 

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