Kathleen D. Schaum, MS
Medicare coverage for distinct types of wounds/ulcers has received attention for many years. Because the theme of this issue of Advances in Skin & Wound Care is pressure injuries (PIs), this article reviews whether Medicare covers certain technologies and procedures for PIs.
DEBRIDEMENT
Most Medicare Administrative Contractors (MACs) have a Local Coverage Determination (LCD) and Local Coverage Article (LCA) that address the coverage guidelines for debridement of all types of wounds/ulcers, including PIs. Some MACs have a separate debridement LCD/LCA, whereas others include debridement coverage guidelines within their LCD/LCA related to wound care. Readers should check their MAC’s LCDs, which do not limit debridement to distinct wound types. However, their LCDs/LCAs have similar coverage guidelines that include, but are not limited to, documentation of:
- History and physical examination with an initial wound description, location, measurements, and response to prior treatment (if applicable).
- Identification of wound location, size, depth, and stage (supported by a drawing or photograph of the wound).
- Clinical documentation of diagnosis or symptoms to justify services.
- Current progress notes including measurable signs of healing as well as causes of delayed wound healing or modifications to the treatment plan.
- Documentation of the wound’s characteristics (e.g., dimensions, necrotic tissue presence, tissue removed, degree of epithelialization) before and after debridement.
- Operative note or procedure note for debridement services, including descriptions of tissue debrided, wound measurements, and pre-/post-debridement wound assessments.
- Plan of care containing treatment goals and physician follow-up.read full article
Kathleen D. Schaum, MS, is a healthcare reimbursement expert specializing in wound care, durable medical equipment (DME), and Medicare coverage policies. She is the president and founder of Kathleen D. Schaum & Associates, a consulting firm focused on payment strategies for healthcare providers and manufacturers. Schaum is a frequent author and speaker on reimbursement-related topics in wound care and medical technology.