Surgical dressings can be used for all types of qualifying ulcers. This includes arterial ulcers, venous ulcers, diabetic foot ulcers, and pressure ulcers. It is important to use the correct diagnosis codes for each of these ulcer types. Diabetic foot ulcer codes should start with L97-. Stasis ulcer codes begin with I83-. L89- codes are […]
The Centers for Medicare and Medicaid Services (CMS) require that DME suppliers maintain proof that any item dispensed was received by the beneficiary in the form of a Proof of Delivery document. This document must be maintained for at least seven years. This could be requested by DMEMACs, recovery auditors, supplemental medical review contractors, or […]
If a patient has bilateral ulcers that both qualify for surgical dressings, you can supply dressings for both ulcers at the same encounter. When doing so, it is important to indicate that two ulcers are being treated by listing modifier “A2” in box 24d of the CMS-1500 form (Health Insurance Claim Form). Appropriate modifier use […]
Among the requirements that must be satisfied when dispensing surgical dressings and compression garments is a face-to-face (FTF) examination. This FTF exam must take place within six months of the time the order is written for the surgical dressing(s) or compression garment. It is acceptable if the FTF exam takes place on the same day […]
Compression is an essential component of both healing and preventing venous leg ulcers. Not only do compression garments, such as the EXTREMIT-EASE® Compression Garment, help to treat difficult lower leg ulcers, they can also be stocked in your office and dispensed to patients as a DME item, providing your patients with excellent care and providing […]
One of the most important steps to ensure clean billing of surgical dressings is the appropriate use of the A- modifier. The A- modifier must be used to indicate two things: Is the dressing billed for a primary or secondary dressing? How many wounds are being treated with the dispensed dressing? An important differentiation is […]
Does dispensing surgical dressings at the same encounter as an ulcer debridement count as an evaluation and management (E/M)? Short answer: Probably not. Longer answer: It depends. It depends on what was performed, documented, and medically necessary. You can submit an E/M at the same time as a debridement (or any procedure) if—and only if—an […]
The surgical dressings available from AMERX Health Care are only covered by a patient’s insurance if they are being used for a surgical wound or a debrided wound. This debridement can be surgical, mechanical, chemical or autolytic. When performing a surgical debridement, both the CPT code selection and ICD-10 code selection are important. CPT Coding […]
Some surgical dressings only have coverage for full thickness ulcers. These include alginates, foams, and hydrogels. When dispensing a dressing that is only covered for full thickness ulcers, it is important to not only document the presence of a full thickness ulcer, but also submit a diagnosis code that reflects the presence of a full […]
While some physicians may interchange the terms “ulcer” and “wound” as if they are synonyms, when it comes to ICD-10, your choice of words DOES matter! What is the Difference between a Wound and an Ulcer? In ICD-10 language, a “wound” is something traumatic. An “ulcer” refers to a break in the skin that fails […]