An important tenant of wound care is moisture balance. The goal is always to maintain a moist healing environment without allowing the wound bed to become too moist, or too dry. When a wound is heavily draining, there is often too much moisture. Excess moisture can be addressed with foam or calcium alginate. We may also encounter the opposite situation where the wound bed is too dry. In this situation, hydrogel introduces moisture to help maintain a moist wound healing environment. Once applied to the wound site, hydrogel will liquefy. Liquification allows hydrogel to migrate across the wound surface and occurs when it is brought to body temperature. Compared to other options, hydrogel sustains moisture longer than standard glycerin and saline-based hydrogel.
Combining with Other Dressings
Hydrogel is a primary dressing and, therefore, requires a secondary dressing for securement. As suppliers, we can dispense both the primary dressing and the secondary dressing. Dispensing both dressing options provides the patient with everything they need and can increase profits in the surgical dressing program. As we addressed in a previous blog post, when combining a primary and secondary dressing, their indications should be the same. Therefore, an option to consider as a secondary dressing over hydrogel is AMERX Bordered Gauze Dressing.
Beyond establishing medical necessity, the documentation requirements must also depict that the wound being treated has “zero to light” drainage and is a Stage III or Stage IV wound for hydrogel to be covered by the DMEMACs. Hydrogel is not covered if the note does not indicate the staging of the wound and if the documentation indicates a Stage I or II wound is being treated. Even after payment is made, recoupments can occur if inadequate or inconsistent documentation is discovered later.
Hydrogel provides moisture to wounds with “zero to light” drainage. DMEMAC coverage allows up to 3 ounces per month per ulcer when medically necessary. Hydrogel is appropriate for Stage III and Stage IV wounds.
DISCLAIMER: The information provided here is intended to educate health care providers regarding compliance with ICD, CPT, and HCPCS coding. The information provided does not guarantee reimbursement and is accurate to the best of our knowledge at the time of this publication. Coding guidelines can change and we encourage you to stay up to date. The existence of a code does not guarantee payment.
Dr. Lehrman is in private practice in Fort Collins, CO and operates Lehrman Consulting, LLC. 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. He is a Fellow of the American Academy of Podiatric Practice Management and an Expert Panelist on Codingline. In his role as a Consultant to the APMA Health Policy and Practice Department, Dr. Lehrman serves as an advisor to the APMA Coding Committee and the APMA MACRA Task Force. Dr. Lehrman sits on the board of directors of both the American Professional Wound Care Association and the American Society of Podiatric Surgeons. He is also on the editorial advisory board of the journal WOUNDS.