Criteria for Medicare Part B Claims

Collagen Dressings Or Wound Fillers (A6010, A6011, A6021-A6024)

Documentation Criteria for Billing Wound Dressing Claims

Wound location.
Wound type – pressure, diabetic, venous, arterial, surgical, trauma, other.
Depth of tissue involvement – partial-thickness, full-thickness, undermining, tunneling, exposed structure.
Exudate amount – scant, minimal, moderate, heavy, copious.
Exudate consistency – color, odor.
Wound bed tissue type(s) or color(s).
Periwound, wound edges, and surrounding skin.
Pain level – location, duration, frequency.
Use appropriate primary (collagen, alginate i.e.) and secondary dressing (foam, hydrocolloid i.e.) based on the wound assessment.
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.