AMERX Health Care provides extensive and detailed guidance to the AMERX Network of Physicians. This guidance covers compliance when dispensing surgical dressings and includes documentation requirements.  Many providers are comfortable with the documentation that is required when initially dispensing surgical dressings.  However, it is just as important to be comfortable with the regulations regarding the need to update this documented information.

Monthly Evaluation Updates

The DMEMAC Surgical Dressings Local Coverage Article tells us that the clinical information that demonstrates the medical necessity of the surgical dressings being used, along with the documentation requirements for that dressing type, must be updated on a monthly basis if the patient is using the product(s) for more than one month.

Weekly Evaluation Updates

This update must be performed weekly if the patient who has received surgical dressings is in a nursing facility or if the patient has a heavily draining or infected wound.  In this situation, the update may be performed by the prescribing / dispensing physician, a nurse, or any health care professional that is involved in the regular care of the patient.

Contents of the Evaluation

According to the above-referenced Local Coverage Article, this monthly or weekly evaluation should include:

  1. Wound type(s)
  2. Wound(s) location
  3. Wound(s) size
  4. Wound(s) drainage
  5. Any other relevant wound status information

The supplier does not necessarily have to perform this update.  Compliance can be met if another party performs the evaluation, the supplier obtains the information, retains it in the patient’s record, and documents the source and date obtained.

In Conclusion

A periodic update of certain clinical information is often required for patients who have received surgical dressings.  The frequency with which that update is required varies based upon the criteria described above.  Be sure to properly obtain and document not only the information required when initially dispensing but also the information required for these recurring updates.

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.

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