Home Oxygen Therapy – Medical Record Requirements

The Medical Record must contain sufficient documentation to substantiate the need for home oxygen therapy. According to the MLN Booklet for Home Oxygen Therapy, this would include the following:

• Type, quantity and frequency of use.
• Meet LCD Requirements
• Support for the patient’s continued need for:
  • Oxygen therapy in home
  • Use of oxygen equipment

• The Certificate of Medical Necessity (CMN). The information found in the patient’s medical record and the information found in the supplier’s records must correlate with the information on the CMN.
• All medical records must be kept for 7 years from the date of service (DOS).

Patient Information to be included in the Medical Record (This is also in the MLN Booklet):

• Diagnosis
• Duration of condition
• Clinical course (worsening or improving)
• Prognosis
• Results of the blood gas study, either printed data from test or written in the notes
• If portable oxygen is needed, an indication that patient is mobile within the home
• Nature and extent of functional limitations
• Other therapeutic interventions and results
• Past experience with related items and
• Any other information that might be pertinent

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