TOO MANY DRESSING CHOICES!!!! WOUND CARE MANAGEMENT AND PRODUCTS. Should Your Practice Dispense Wound Care Supplies? Pros:

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1 WOUND CARE MANAGEMENT AND PRODUCTS Animesh Bhatia DPM, CWS, FAPWCA Board Certified Wound Specialist Diplomate, American Academy of Wound Management Fellow, American Professional Wound Care Association Fellow, American Academy of Podiatric Practice Management Asst. Medical Director, Wound Clinic at Fairfield Hospital, Columbus, Ohio Factors Influencing Dressing Choice Anatomical site Amount of exudate Dead space Surrounding skin Caregiver ability Wound status Aggressive therapy vs. palliative care Cost Reimbursement Should Your Practice Dispense Wound Care Supplies? Cons: Inventory costs minimal! Staff training just do it! Myriad Supply choices----start with a few Insurance rules, DME regulations---read LCDs Reimbursement hassles---none if you follow a few basic rules Should Your Practice Dispense Wound Care Supplies? Pros: -Direct patient supply Care begins immediately Less patient confusion of supply use COMPLIANCE, baby - Helps stay current on new products TOO MANY DRESSING CHOICES!!!! ****IMPORTANT*** Disclaimer ***Information provided is to the best of our knowledge and as current as possible. ***Please verify all policy and reimbursement information with your local DME carriers. ***Cost and reimbursement numbers are approximate and may vary by product and state respectively. ***Check DME HCSPCS Codes for Surgical Dressings (attached) and PDAC Product listings for most appropriate code for product being dispensed 1

2 Calcium Alginates Brown seaweed Extremely absorbant Patient must have moderate to heavy drainage (note must reflect this) Cannot be used with hydrogels Available in ropes for filling and flat pads for open wounds Interacts with wound exudate to form a moist gel May use in infected wounds Calcium Alginates A6196 A6197 A6199 Up to 30 pieces per month per wound allowed Cost: $3-$5 Reimbursement: $6-$8 Example: Silvercel Alginate Dressings Very absorbant Notes need to reflect moderate to heavy drainage Have film, adhesive or no backing on outer surface Semiocclusive Filler in dead space Does not adhere to wound bed Not always useful for dry eschar Cannot be used with hydrogels A6209-A6214 based on size, adhesive Up to 12 pieces per wound month allowed Cost: $1-$12 Reimbursement: $8-$20 per unit Example: PolyMem 2

3 Collagens Absorbent, conformable and nonadherent Note needs to indicate Mild, moderate, or heavy drainage Available in pads, particles, powders, paste and ribbons/strips Can use in Infected wounds and Tunneling wounds Provides matrix for tissue and vessel growth Not recommended for 3 rd degree burns, dry eschar or necrotic wounds May be composed of bovine material watch for sensitivities Collagens A6010-A6024 A6021 Collagen pad less than 16 sq cm Up to 30 pieces per wound per month allowed Cost: $11-$12 Reimbursement:$21 Example: Prisma Collagen Dressings Notes need to reflect none to light drainage Available in amorphous gels, sheets, or impregnated in gauze Helps maintain a moist healing environment In gauze form can be used to fill wounds Can use when infection is present w/ topical antibiotics May cause maceration if exudate increases Gauze (A6231-A6233) Pads (A6242-A6247) (A6248) Gel Gels: up to 3 ounces per wound per month allowed----amerigel Wound dressing Cost: $9-$12 Reimbursement: $16 Gauze: up to 30 pieces per wound per month allowed Cost: $2 per piece Reimbursement: $5 Example: Amerigel saturated gauze 3

4 Number of Wounds being treated: A# Placed in Box 24d of the HCFA 1500 form If one wound being treated: If two wounds being treated: And so on A1 A2 Example: Prisma A6021 (Collagen) DMERC reimbursement: $22.02 per dressing Cost: 4x 4 size, Supplied in Box of 10 = $110=$11 per dressing Profit: $11 per dressing Allowed: Max. 30 dressings per wound per month Max. Profit per wound per month$ 330 *I do not recommend dispensing 30. In most cases, you should dispense as many as they need till the next visit. Wound Supplies are a covered benefit under Medicare Part B if they are Medically Necessary, and: They are used in the treatment of a wound caused by or treated by a surgical procedure When debridement of a wound is medically necessary, therefore the wound needs to have been debrided Progress Note Documentation Describe wound (size, depth, appearance) Method of debridement (scalpel, nippers) Depth of debridement Partial, Full thickness, SQ, Muscle, Bone Dressings Post-Op care Treatment Plan DME Documentation Type of dressing Dressing size Number of dressings dispensed Number of wounds being treated Frequency of dressing changes Anticipated duration of dressing requirement Type of wound Wound location, Size, and Depth Amount of Drainage Has the wound been Debrided? 4

5 PRACTICE PEARLS AND STRATEGIES Know indication and applications of product Know shelf life and Cost of product PDAC approved? Check for Product Listing Know the frequency allowed HCSPCS code of product, and reimbursement amount DME DOCUMENTATION!!! At some point you WILL be asked for it Proof of delivery, Supplier Standards, Warranty, Instructions, Progress note Cannot dispense if on Part A stay, Hospice or under Home health care Wound Bed Preparation---In other words, DO THIS FIRST!! Debride Manage infection Offload Compress Maintain moist wound, using dressings OR Absorb drainage, using dressings Vascular workup (ABI, TBI s at office) Xray Biopsy Diagnostic ultrasound Nutrition consult Bloodwork (ESR, CRP, PREALBUMIN, ALBUMIN, HbA1C etc) 5