Reimbursement of Wound Care Products

Purpose:

To deliver evidence-based advanced wound care while utilizing established and developed medical standards to optimize wound healing outcomes:

• Weekly wound assessment should include:

  1. Wound location
  2. Wound type – pressure, diabetic, venous, arterial, surgical, trauma, other.
  3. Depth of tissue involvement – partial-thickness, full-thickness, undermining, tunneling, exposed structure.
  4. Exudate amount – scant, minimal, moderate, heavy, copious
  5. Exudate consistency – color, odor
  6. Wound bed tissue type(s) or color(s)
  7. Periwound, wound edges, and surrounding skin
  8. Pain level – location, duration, frequency
• Use appropriate primary dressing, collagen formulation (KollagenTM particles, sheet, or gel) based on wound assessment.
• Secondary dressings are used as a cover dressing: e.g., transparent, gauze, abdominal pad, foam, super-absorbent pad, hydrocolloid, Unna's boot, and multi-layer wrap. 
• Dressing size is determined by wound measurements that may or may not include periwound. A larger dressing may be used if the clinical rationale supports product size.
• Physician progress note/wound note must substantiate advanced wound care products and frequency of change.
• Wound photos can be used as an adjunct to written documentation.  Always follow your policy and procedures.
• Physician detailed written order must be signed and dated for each product billed, including # of dressings and directions for us. Orders may be placed every 30 days per Medicare Part B guidelines.
• The physician will monitor wound progress and treatment plan weekly and make changes to treatments as appropriate if no wound healing progress >2 weeks.