RETIRED - Correct Coding - Surgical Dressings Containing Unclassified Materials - JD DME
RETIRED - Correct Coding - Surgical Dressings Containing Unclassified Materials
Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.
DME MAC Joint Publication
Note: A previous version of this article was published in January 2015. The January publication was subsequently removed due to an inaccuracy in a reference to A9270. This article replaces that previous publication.
Some multi-component surgical dressings contain materials for which no specific HCPCS code exists. This article reviews the coding guidelines for these items.
Historically, materials not having specific HCPCS codes have not comprised the majority constituent(s) in multi-component products. Thus, these materials were not taken into consideration for HCPCS coding purposes. The longstanding coding guideline for multi-component dressings states that the clinically predominant component will determine classification. The current Surgical Dressings Local Coverage Determination (LCD) related Policy Article (PA) Coding Guidelines says:
Products containing multiple materials are categorized according to the clinically predominant component (e.g., alginate, collagen, foam, gauze, hydrocolloid, hydrogel). Other multi-component wound dressings not containing these specified components may be classified as composite or specialty absorptive dressings if the definition of these categories has been met. Multi-component products may not be unbundled and billed as the separate components of the dressing.
Recently, multi-component dressings with non-classified (non-coded) components comprising the majority of the dressing's materials have been identified. The following clarification to the current guideline is being published in order to assure consistent interpretation of the "clinically predominant component" criterion. The revised coding guidelines clarify how products with non-coded materials are to be classified:
Multi-component dressings that are not classified as composite dressings are categorized according to the clinically predominant component. The clinically predominant component is defined based on the proportion of material(s) in the dressing. For example, a dressing that is 60 percent hydrocolloid and 40 percent alginates would be categorized as a hydrocolloid dressing. HCPCS coding is determined based on the following:
- Products where a single material comprises greater than 50% (by weight) of a product's composition are coded based upon the applicable specific HCPCS code for that material. If a specific HCPCS code does not exist for the predominant component, HCPCS code A4649 (Surgical Supply, miscellaneous) is used.
- Products where no single material comprises greater than 50% (by weight) of the composition are coded as A4649 (Surgical Supply, miscellaneous).
The Surgical Dressings LCD related Policy Article Coding Guideline section will be updated to include this information.
Refer to the Surgical Dressing LCD and related PA for additional information about coding and coverage.
For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/.
Last Updated Thu, 10 Jan 2019 12:59:48 +0000