Dispensing Primary and Secondary Dressings With Different Change Frequencies

When dispensing surgical dressings, it is important to differentiate between primary and secondary dressings and to use them in conjunction when indicated.

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

A primary and a secondary dressing can both be dispensed at the same time for the same ulcer when indicated.  For example, collagen powder as a primary and foam as a secondary can be dispensed together for the same ulcer.


When dispensing both a primary and secondary dressing for the same ulcer at the same time, certain guidelines must be followed:

  1. The medical necessity for both should exist and be documented.
  2. Two primary dressings should not be dispensed at the same time for the same ulcer.
  3. The primary and secondary dressing should not have different indications.

Change Frequencies

The DMEMAC LCD for surgical dressings tells us that “when combinations of primary dressings, secondary dressings, and wound fillers are used, the change frequencies of the individual products should be similar.”  It does not say they have to be identical.

A good example is the one given above, collagen powder and foam.  A 30-day supply for daily change and a 12-day supply for a change every 2-3 days are not identical, but certainly are similar.  The LCD goes on to instruct that in a situation like this, “the product in contact with the wound determines the change frequency.”  This does not impact quantity restrictions on either product.  In our example above, 30 days of collagen and 12 days of foam may be dispensed at the same visit when indicated.


Dispensing both a primary and secondary dressing for the same ulcer at the same encounter can provide excellent, thorough patient care, and also improve profits enjoyed when participating in the surgical dressing program.

When dispensing both a primary and secondary dressing for the same ulcer at the same encounter, be sure the guidelines above are followed and remember that when the two dressings have different, but similar, change frequencies, it is the dressing in contact with the wound that determines the change frequency.

DISCLAIMER: The information provided here is intended to educate health care providers regarding compliance for 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.

About the Author

Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

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.

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