Can You Bill For Two Different Dressings For The Same Ulcer? The answer is…YES!

When can you dispense two dressings for the same ulcer? When a primary dressing, like collagen powder, is dispensed and requires a secondary dressing for securement, you can dispense both the primary and secondary dressings for the same ulcer-and bill for both.

Primary Versus Secondary Dressings

Some products can only serve as a primary dressing, while others can serve as either primary or secondary dressings.

  • Primary surgical dressings are therapeutic or protective and can be applied directly to ulcers.
  • Secondary dressings are also therapeutic or protective and are needed to secure and/or aid in the function of a primary dressing.

Guidelines to Follow

  • When dispensing primary and secondary dressings for the same ulcer, be sure to document the medical necessity of both dressings.
  • It is recommended that the frequency with which both primary and secondary dressings need to be changed is the same. For example, dispensing a primary dressing, which should be changed daily, along with a secondary dressing, which should be changed weekly, is not a suggested combination.
  • You should not dispense two dressings for the same ulcer at the same time that have different indications.
  • Finally, if the design of the primary dressing is such that it does not require a secondary dressing, a secondary dressing should not be dispensed. Examples of primary dressings that do not require a secondary dressing include those that have an impervious outer layer and those that have an adhesive border.

Conclusion

Dispensing two different surgical dressings for the same ulcer can help to ensure your patient has everything they need to care for their ulcer. Doing so can help to achieve excellent outcomes and provide high-quality care. Appropriately dispensing two dressings for the same ulcer at the same visit can also increase your per visit value and add to the profitability and success of your in-office DME program.

Resource: DME MAC Surgical Dressing Policy Local Coverage Determination (LCD) (L33831)– September 2017

Primary Dressings by AMERX

  • AMERIGEL Hydrogel Wound Dressing
  • AMERX Calcium Alginate Dressing
  • AMERX Foam Dressing
  • AMERX Bordered Foam Dressing
  • AMREX Bordered Gauze Dressing
  • AMERX Hydrocolloid Dressing
  • HELIX3-CM Collagen Matrix
  • HELIX3-CP Collagen Powder

Secondary Dressings by AMERX

  • AMERX Bordered Foam Dressing
  • AMERX Bordered Gauze Dressing
  • AMERX Calcium Alginate Dressing

* Post updated 11/04/2020 to reflect DMEMACs change to joint Surgical Dressing Local Coverage Article (LCA)

Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
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Dr. Lehrman is a podiatrist practicing in Fort Collins, CO and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance and documentation. Dr. Lehrman is a Certified Professional Coder and Certified Professional Medical Auditor. He serves as a staff liaison at the AMA CPT® Editorial Panel meetings where CPT codes are created, edited, and deleted. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. Dr Lehrman is a Fellow of the American Academy of Podiatric Practice Management, Past Director of the American Professional Wound Care Association Board of Directors, and is a Past Chairman of the Board of the American Society of Podiatric Surgeons. Dr. Lehrman is also on the editorial advisory board of the journal WOUNDS.