Monday, March 28, 2011

Reimbursement for Surgical Dressings

Updated 3/2017-- all links removed as many are no longer active and it was easier than checking each one.

I opted out of Medicare many years ago, so I could skip articles like the one referenced below.  I don’t.  
Kathleen Schaum writes a very informative article on the ins & outs of reimbursement for surgical dressings.  She gives a self-test to help you and your team assess your knowledge:
….If you pass the LCD/Article self-test, congratulate yourself for a job well done. If you do not pass the self-test, you should immediately take steps to become compliant. Let's start the self-test now.
* Do you know how to find the LCD for Surgical Dressings and the Surgical Dressing Policy Article that is pertinent to the geography that you serve?
If yes, have you printed both documents, read them, and shared them with your entire wound care team? If no, the Web sites in Table 1 will connect you with each of the DME MACs' LCDs and Articles. Remember that your wound care patients are counting on you to understand and implement a process that will meet all the LCD/Article guidelines.
* Can you correctly answer these frequently asked questions?
Unfortunately, the LCD for Surgical Dressings and its attached Article have been either forgotten by or not introduced to some modern-day wound care professionals. ……...
Q: Why do medical suppliers tell my patients with skin tears that Medicare does not cover the dressings that I order?
A. Wound dressings are covered by Medicare when they are used on a surgical wound, partial-, or full-thickness skin wound, or partial- or full-thickness burn. Dressings are not covered for skin tears, abrasions, Stage I ulcers, first-degree burns, or cutaneous fistulas unrelated to a surgical procedure.

The helpful web sites given in Table 1 of the article:
CIGNA Government Services (CIGNA) –
National Government Services (NGS) –
National Heritage Insurance company (NHIC) –
Noridian Administrative Services (Noridian) –

Can You Pass the Surgical Dressing Ordering and Documentation Test?; Schaum, Kathleen D.; Advances in Skin & Wound Care. 24(3):112-117, March 2011; doi: 10.1097/01.ASW.0000395044.66516.02

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