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.

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