Documentation for Surgical Dressings

March 9th, 2018 - Medicare Learning Network
Categories:   Documentation Guidelines   HCPCS Coding   Modifiers  
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The 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

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