Clinicians! Are You Ordering Surgical Dressings for Your Patients?

In order for a DME supplier to provide surgical dressings to patients, the medical record must show that the number and type of surgical dressings is medically necessary according to the coverage criteria below.

Coverage Criteria Documentation Requirements

Surgical dressings are covered for two types of qualifying wounds:

  1. A wound caused by a surgical procedure; or,
  2. After the debridement of a wound (surgical, mechanical, chemical, or autolytic)

Surgical dressings must be tailored to the needs of the individual patient. Dressing size must be appropriate to the size of the wound, generally about 2 inches greater than the dimensions of the wound. Both primary dressings (applied directly to wounds) and secondary dressings (used to secure a primary dressing) are covered.

In addition to the standard order requirements, the detailed written order for a surgical dressing must specify:

  • The type of dressing (e.g., hydrocolloid wound cover, hydrogel wound filler, etc.); and,
  • The size of the dressing (if applicable); and,
  • The number/amount to be used at one time (if more than one); and,
  • The frequency of dressing change

These requirements are included on the detailed written order. You will likely receive this document from the supplier and it will need to be reviewed/signed/dated and returned to them before they can submit their claim to Medicare.

A new order is needed when a new dressing type is added or if the quantity needs to be increased. A new order is also required every 3 months for each dressing used.

Clinical information defining the number of wounds, the reason for dressing use, and whether the dressing is being used as a primary or secondary dressing or for some noncovered use (e.g., wound cleansing) must be available to the supplier from the physician, nursing home, or home care nursing records. 

Wound evaluations must be updated by the treating physician (or their designee) on a monthly basis; however, wound evaluation is expected on a weekly basis for beneficiaries in a nursing facility or for beneficiaries with heavily draining or infected wounds. The evaluation may be performed by a nurse, physician or other health care professional involved in the regular care of the beneficiary. This evaluation must include:

  • The type of each wound (e.g., surgical wound, pressure ulcer, burn, etc.)
  • Wound(s) location,
  • Wound size (length x width) and depth
  • Amount of drainage
  • Any other relevant wound status information

Documentation needs to be available to the supplier when requested.

Resources

 

Last Updated Feb 10, 2020