If a surgical dressing will be needed following a surgery, may we dispense the dressing prior to the surgery and submit a claim for payment to a third-party payer the day it is dispensed? The Answer: Probably not.
Medical Necessity is the Key
For Medicare beneficiaries, surgical dressings may be provided and billed prior to surgery only when the item is medically necessary, the dressing is required to be used prior to surgery, coverage criteria is met, and documentation to substantiate the need is included in the ordering physician’s medical record. If there is no medical need to use the dressing until after the surgery, the item should not be provided until after the surgery has been performed and the medical need is clearly established in the documentation. The DME Medicare Administrative Contractors (MACs) do not provide for any exceptions to this policy, including convenience issues.
Most non-Medicare payers with surgical dressing coverage follow these same Medicare guidelines.
When It May Be Allowed
A patient with a chronic wound may demonstrate the medical necessity to have collagen powder dispensed prior to a planned surgery for that wound. If a patient presents today with a chronic wound that requires a surgical procedure, and also demonstrates the medical necessity for collagen powder today, and that same collagen powder will be needed after the surgery that is planned for one week from today, the collagen may be dispensed today because it is medically necessary for the patient to use that collagen today.
Reference
DMEMAC “Providing Items Prior to Surgery” https://med.noridianmedicare.com/web/jadme/article-detail/-/view/6547796/providing-items-prior-to-surgery
