HBOT is described as a treatment that utilizes pure oxygen in a high-pressure environment to aid in healing wounds/tissue that have been damaged by infection, poisoning or injuries.  There must be an initial HBOT evaluation and/or consultation by a physician or nurse practitioner (NPP). Physician or Non-Physician Practitioner (NPP) order for date of service, if applicable. The documentation is very specific to the prescribing of HBOT as well as the treatment rendered. 

Progress notes 

• HBO clinic/progress notes 
• Clinic/hospital/progress notes prior to starting HBO, if applicable 
• Support of the initial wound/condition etiology 
• Support of prior history of treatment for the condition/wound(s), if applicable 

HBO Treatment plan 

• Atmospheric pressures 
• Rest/Air breaks 
• Frequency and number of dives 
• Blood glucose monitoring, if applicable 
• Wound assessments, if applicable 
• Evaluation of progress 

HBO dive logs/treatment records 

• Documentation should include minutes completed during HBO treatment 
• Documentation should support when blood glucose measurements are taken and the results, if applicable 

Wound treatment records or wound flow sheets supporting measurable signs of healing 

• Wound measurements, if applicable 
• Subjective findings regarding wound, if applicable 

Diabetic wound(s) required documentation: 

• Wagner grade classification (must be Wagner grade III of higher) with diagnostic testing to support Wagner grade; 
• Patients have type 1 or type 2 diabetes and lower extremity wound due to diabetes. 
• Documentation supporting prior failed treatment using standard wound care. 
• Documentation supporting there were no measurable signs of healing for at least 30 consecutive days of treatment when using standard wound therapy. 
• Evaluation of wound(s) at least every 30 days during administration of HBO therapy that supports evidence of measurable signs of healing 

Standard diabetic wound care therapy documentation required prior to starting HBO: 

• Assessment of patient's vascular status and correction of problems, if applicable 
• Support for optimization of nutritional status 
• Support of optimization of glucose control 
• Support of debridement of the devitalized tissue 
• Support of the wound care management that includes maintenance of a clean, moist bed of granulated tissue with appropriate moist dressing 
• Support of appropriate off-loading 
• Support of treatment to resolve infection 

There must be separate documentation for an evaluation and management (E&M) service if provided on the same date of service as treatment. 

The patient must be provided an Advance Beneficiary Notice of Noncoverage (ABN), if applicable. 

Jane Keesler, AA, CCS 

Senior Consultant at UASI



Jane Keesler is a Senior Consultant at UASI, with a background in Inpatient, Outpatient, Hospice,  Home Health, Dental, DME coding, DRG/APC validation, and HIM auditing across complex hospital cases. She shares clear, practical coding tips grounded in real audit findings to help coders strengthen accuracy, defensible DRG assignment, and compliant documentation. 

Works Cited:

Cleveland Clinic. (n.d.). Hyperbaric oxygen therapy.
Available at https://my.clevelandclinic.org/health/treatments/17811-hyperbaric-oxygen-therapy

Mayo Clinic. (n.d.). Hyperbaric oxygen therapy. Mayo Foundation for Medical Education and Research.
Available at https://www.mayoclinic.org/tests-procedures/hyperbaric-oxygen-therapy/about/pac-20394380

Centers for Medicare & Medicaid Services. (n.d.). National Coverage Determination (NCD) for Hyperbaric Oxygen Therapy (20.29). Available at https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=12&ncdver=3&DocID=20.29