
Documentation for Surgical Dressings
March 9th, 2018 - Medicare Learning NetworkThe Medicare Learning Network provides guidance on required documentation for surgical dressings.
The following Medicare coverage guidance applies to surgical dressing claims:
- Surgical dressings are covered when a qualifying wound is present. A qualifying wound is defined as either of the following:
- A wound caused by, or treated by, a surgical procedure
- A wound that requires debridement, regardless of the debridement technique
- Products that are eligible to be classified as a surgical dressings include both:
- Primary dressings – Defined as therapeutic or protective coverings applied directly to wounds or lesions either on the skin or caused by an opening to the skin
- Secondary dressings – Defined as materials that serve a therapeutic or protective function and that are needed to secure a primary dressing
- Dressingsoverapercutaneous catheter or tube are covered as long as the tube or catheter remains in place, and after removal until the wound heals
- Dressing size must be appropriate to the size of the wound
- Orders
- The order must specify:
- Type of dressing (hydrocolloid cover, hydrogel filler)
- Size of the dressing
- Number/amount to be used at one time
- Frequency of the dressing change
- Expected duration of need
There must be a written, signed, and dated order. This must be received by the supplier before the claim can be submitted
- New order if a new dressing is added or if the quantity of an existing dressing is increased
- New order at least every three months for each dressing being used
- Clinical documentation must include:
- Number of surgical/debrided wounds treated with a dressing, reason for, and whether the dressing is being used as a primary or secondary dressing (must be obtained from the physician, nursing home, or home care nurse)
- Clinical information that is up to date and supports the necessity of the type and amount of surgical dressings
- Documentation of monthly or more frequent wound evaluations (more frequent for those in nursing facilities or with heavily draining/infected wounds).
Assessments to include:
- Type of wounds
- Location
- Size (Length x Width cm.)
- Depth
- Drainage Amount
- Code Specific requirements
- When codes A4649, A6261 or A6262 are used, there must be a narrative description of the product, manufacturer, brand name/number, and information justifying medical necessity
- The appropriate modifier (A1 – A9, AW, EY, or GY) must be added when applicable
- For specific coverage guidelines, please see Surgical Dressings LCD L33831
- For additional guidance on Medical Record Documentation Requirements and Medicare Signature Requirements, please see Complying With Medical Record Documentation Requirements and Complying with Medicare Signature Requirements.
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