INTEGRATED THERAPEUTIC SOLUTIONS TO MANAGE AND PREVENT DIABETIC FOOT ULCERS

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INTEGRATED THERAPEUTIC SOLUTIONS TO MANAGE AND PREVENT DIABETIC FOOT ULCERS UE REMOVE EXU D R IA ER T C D TISS UIL EB ATE AN DB A REMOVE REBUILD REDUCE Cutimed Siltec Sorbact featuring DACC Technology Cutimed Epiona Native Collagen Dressing Cutimed Off-Loader Select REDU THERAPIES. HAND IN HAND. CE PRESSURE

CHALLENGE: Without Total Contact Casting Diabetic Foot Ulcers Take Longer to Heal and Are Costly Approximately 1/3 of diabetic treatment costs in the U.S. are spent on treating diabetic foot ulcers, and 85% of lower extremity amputations are preceded by a DFU. 1 2 Timely wound healing is less likely without comprehensive management, including off-loading. 2 Management of peripheral artery disease (PAD) Infection management Debridement Off-loading with a total contact cast Maintaining a moist wound environment

SOLUTION: An Integrated Therapy Approach Remove, Rebuild, Reduce Promotes Faster Healing Is it Possible to Improve the Outcome? Aggressive off-loading of neuropathic plantar ulcers in diabetic patients is not an adjunct therapy to treatment it is the most extensively studied treatment 4 Advanced therapeutics are unlikely to succeed in improving wound healing outcomes unless effective off-loading is achieved Increased healing of a DFU is more likely to occur with adherence to off-loading REMOVE EXUDATE AND BACTERIA REMOVE REBUILD CUTIMED SILTEC SORBACT Silicone Foam Dressing Featuring DACC Technology REDUCE Binds and inactivates bacteria Smart Pore Structure allows vertical absorption of exudate Super-absorbent particles lock in wound exudate reducing risk of maceration Effectively absorbs highly viscous exudate REMOVE REDUCE REBUILD REBUILD TISSUE CUTIMED EPIONA Collagen Dressing with 3D Matrix Technology Cutimed Epiona is a native collagen, absorbent wound dressing developed with the same microstructure as the intact collagen network of human skin. Captures and binds excessive proteases and inflammation-inducing elements (MMPs) to help protect the growth factors that stimulate healing Reduces enzymatic degradation from inflammatory cells by binding MMPs Delivers structural support for proliferation of vital cells needed for wound repair 5 Creates an ECM-like scaffold encouraging cell proliferation and tissue growth

Total Contact Casting Proven Advantages for Off-Loading T CC has consistently demonstrated the best healing outcomes Evidence shows that when off-loading is integrated into patient care and provided at each visit, the likelihood of DFU healing increases, and the chance for complications decreases3 Advanced therapies are unlikely to succeed in improving outcomes unless effective off-loading is acheived.3

Off-Loading Therapy From BSN: Customizable, Easy to Apply and Remove REMOVE REDUCE REBUILD REDUCE PRESSURE CUTIMED OFF-LOADER SELECT TCC System TRUE Total Contact Casting Customizable for most legs Cost-effective Easy to apply and remove 90% Clinical and Economic Benefits of Healing Diabetic Foot Ulcers With a Rigid Total Contact Cast Numerous studies have demonstrated TCC s excellent healing performance and results TCC has a healing rate of about 90% within 6-8 weeks 3 healing rate Cutimed Off-Loader Select Offers Superior Results to Newer, More Expensive Therapies 6 % Healed Healing Time Total Contact Cast 80-90% 42 Days Removable Boot 52-74% 38-50 Days Apligraf 56% 65 Days Dermagraft 50% 72 Days PDGF-BB 50% 86 Days Cutimed Off-Loader Select TCC Treatment Pathway VASCULAR ASSESSMENT INFECTION CONTROL ADVANCED DRESSING MANAGEMENT PRESSURE RELIEF WITH OFF-LOADING

Preventing DFU Recurrence Risk Factors for Recurring DFU Deformity, peripheral artery disease, peripheral neuropathy, previous foot wound, and/or a prior amputation are risk factors predictive of new or recurrent DFU 3 The more risk factors that are present, the more likely DFU will occur 3 Within 1 year of wound healing following DFU, up to 60% of patients with a previous DFU history will develop a recurrent wound 3 The first step in DFU preventive care is patient education. Ways to Help Ensure Positive Post-Healing Outcomes DFU Education Without sound self-management and proper foot care, DFUs are three times more likely to reoccur Discuss healthy diet, blood sugar levels, weight, daily foot exercise and other key factors Maintain Range of Motion (ROM) As healed DFUs can impact normal ROM, range of joint motion and repetitive foot exercises have been shown to increase blood supply to affected areas, aiding in both healing and future prevention Intelligent Footwear and Device Choices Healing sandals, diabetic socks, and shear-reducing insoles offer both comfort and protection

BSN Advanced Wound Care Solutions For Management of Diabetic Foot Ulcers Adjunctive therapy will work best if the over arching goals include appropriate off-loading while managing the diabetic foot ulcer. BSN offers you and your patients integrated therapy solutions to manage the DFU throughout the healing process.

Ordering Information REMOVE Size Ref-No. Cutimed Siltec Sorbact Dressing* REBUILD Size Ref-No. Cutimed Epiona Collagen Dressing REDUCE Ref-No Description Qty Cutimed Off-Loader Select Synthetic Cutimed Off-Loader Plaster & Synthetic Combination Canvas Rocker Bottom Cast Shoe Please refer to the product label and/or package insert for full instructions on the safe use of these products. 7800901 Cutimed Cavity 1 each 2 x 2 Cotton Gauze 4 each 3 Delta-Lite Conformable 3 rolls 4 Delta-Lite Conformable 2 rolls 3 Delta Terry-Net Stockinette 1 each 4 Specialist 100 Cotton Cast Padding 2 each Delta Terry-Net Adhesive Felt Open Cell Foam 1 each 1 each 7800900 Cutimed Cavity 1 each 2 x 2 Cotton Gauze 4 each 4 Ortho-Flex Elastic Plaster 3 rolls 4 Extra Fast Gypsona S 2 rolls 3 Delta-Lite Conformable 1 each 4 Delta-Lite Conformable 2 each 3 Delta Terry-Net Stockinette 1 each 4 Specialist Cotton Cast Padding 1 each Delta Terry-Net Adhesive Felt Open Cell Foam Dressings/ Box Suggested HCPCS** 3 x 3 in. 7992900 10 A6212 5 x 5 in. 7992901 10 A6212 6 x 6 in. 7992902 10 A6212 7 x 7 in. 7992903 5 A6213 9 x 9 in. 7992904 5 A6213 Sacral 7 x 7 in. 7992905 5 A6213 Sacral 9 x 9 in. 7992906 5 A6214 Dressings/ Box Suggested HCPCS** 2 x 2 in. 7322700 10 A6021 4 x 4 in. 7322701 10 A6021 8 x 8 in. 7323002 10 A6023 1 each 1 each 43101408 Canvas Rocker Bottom Cast Shoe Small 1 each 43101505 Canvas Rocker Bottom Cast Shoe Medium 1 each 43101602 Canvas Rocker Bottom Cast Shoe Large 1 each 43101709 Canvas Rocker Bottom Cast Shoe X-Large 1 each REIMBURSEMENT DISCLAIMER: This document includes suggested HCPCS codes that might be used to bill for BSN medical products and related services. Each provider will have to verify the appropriate codes for each patient. These codes are determined by Noridian Healthcare Solutions as the Pricing, Data Analysis and Coding (PDAC) Contractor of the Centers for Medicare and Medicaid Services. These codes may change at the discretion of the PDAC at any time and BSN is not responsible for such changes. 1. Centers for Disease Control. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. 2. Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008, www.ahrq.gov. 3. Snyder RJ, et al. The Management of Diabetic Foot Ulcers through Optimal Off-loading. Building Consensus Guidelines and Practical Recommendations to Improve Outcomes. Journal of the American Podiatric Medical Association. Vol 104. No. 6. Nov/Dec 2014. 4. Vickie R. Driver MS, DPM, FACFAS; Professor, Orthopedic Surgery Brown University; President, Association for the Advancement of Wound Care, AAWC; Chief Podiatric Surgery, VA Healthcare New England, RI; Director Research Wound Healing, RI Hospital; Director Research Fellowship Program. 5. Data on file. 6. Reyes, Diabetes Care, 2001; Gentzkow, Diabetes Care, 1996; Armstrong, Diabetes Care, 2007; Mueller, Diabetes Care, 1989; Peters, Arch Phys Med Rehab, 2001; Kantor, Margolis, Expected Healing Rates for Chronic Wounds, Wounds 2000, 12: 155-158. It is the supplier or provider s sole responsibility to determine and submit appropriate codes, charges, and modifiers for services rendered. Providers should contact insurers to verify correct coding procedures prior to submitting claims related to any product or service. BSN medical Inc. cannot guarantee coverage or reimbursement with the codes listed in this billing guide. In all cases, providers will need to follow local payer policies for billing and reimbursement. BSN medical Inc. 5825 Carnegie Blvd. Charlotte, NC 28209-4633 Tel. (+1) 704 554 9933 Fax (+1) 800 835 4325 www.bsnmedical.com 62423 RN 2016 BSN medical Inc. REV 01/16