Billing and Reimbursement for Collagen Wound Dressings

When ordering collagen wound dressings or other wound care/surgical dressings, it’s critical to have documentation to back up the medical necessity of the items being billed to the Centers for Medicare and Medicaid Services (CMS). Here are some pointers to make sure your documentation follows CMS’s current criteria.

Criteria for Documentation in Support of Medical Necessity in Billing Reimbursement

  • Weekly wound evaluation (every 7 days)
  • The location of the wound
  • Type of wound – pressure, diabetic, venous, arterial, surgical, trauma, and other wounds.
  • Tissue involvement depth – partial thickness, complete thickness, undermining, tunneling, and exposed structure
  • Amount of exudate – dry, sparse, minimal, moderate, thick, profuse
  • Color, odor, and consistency of exudate
  • Type(s) or color(s) of wound bed tissue (s)
  • The skin around the periwound, the wound margins, and the periwound
  • Pain intensity – where it is, how long it lasts, and how often it occurs
  • Wound measurements, which may or may not include periwound, are used to estimate dressing size. If the clinical rationale supports it, a bigger dressing can be employed.
  • Advanced wound care materials and frequency of change must be documented in the physician progress record/wound note.
  • Photographs of wounds can be used as a supplement to documentation. Always adhere to your company’s policies and procedures.
  • For each product paid, a physician must sign and date a precise written order that includes the number of dressings and guidelines for us. According to Medicare Part B requirements, orders can be placed every 30 days.
  • The physician will check on the wound’s progress and treatment plan on a weekly basis, making changes to the treatment plan as needed if the wound has not healed in more than two weeks.

Collagen Dressings Or Wound Fillers: Medicare Part B Claims Criteria (A6010, A6011, A6021-A6024)

  • Damage that spreads past the epidermis and dermis (all layers of the skin) into the subcutaneous tissue or beyond is referred to as a full-thickness wound (into muscle, bone, tendons, etc.).
  • Wounds of a full thickness draining low to moderate exudate.
  • Wounds that have stagnated or have not advanced near their healing goal.
  • Collagen dressings can stay in place for up to seven days.

 

In order to justify and justify the use of appropriate dressings, a thorough wound assessment is required. Clinicians should be familiar with the formulary, dressing categories, indications, and contraindications at their facility. When used in conjunction with wound bed preparation, moist-wound healing, offloading/redistribution, and continued education, collagen dressings have been demonstrated to bring chronic complex wounds toward a healing trajectory. When choosing advanced wound care products, healthcare providers should examine the quality, product features, price, and availability.

Source

Centers for Medicare & Medicaid Services https://www.cms.gov/Medicare/Coverage/DeterminationProcess/LCDs

Human BioSciences, Inc. blog offers education and tips; however,the information provided by this website or company is not a substitute for medical treatment or advice.

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