In the course of treating an ulcer, it may become medically necessary to switch the surgical dressing a patient is using. For example, AMERX® Calcium Alginate Dressing may be dispensed to address an ulcer that is stalled in the inflammatory phase of wound healing. If this ulcer then progresses to the proliferative phase of wound healing, it may be medically necessary to change from calcium alginate to HELIX3-CP® Collagen Powder to enhance wound contracture and cellular migration.
When a change in dressing type occurs, providers must complete a new Standard Written Order for the new product type.
Whether the dispensing provider must wait for the patient to run out of the supply of the original dressing before switching, it depends on the quantity of that first dressing initially supplied. For example, if a 30-day supply of calcium alginate was originally supplied, it would not be appropriate to dispense collagen until day #31. However, if a 15-day supply of calcium alginate was originally supplied, collagen may be dispensed on day #16. If only a 15-day supply was originally furnished, it is not necessary to wait 30 days before switching.
It may also be possible to switch early if medically necessary after communicating with the payer’s Medical Director office and obtaining authorization to do so.
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Dr. Lehrman is a podiatrist practicing in Fort Collins, CO and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance and documentation. Dr. Lehrman is a Certified Professional Coder and Certified Professional Medical Auditor. He serves as a staff liaison at the AMA CPT® Editorial Panel meetings where CPT codes are created, edited, and deleted. 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. Dr Lehrman is a Fellow of the American Academy of Podiatric Practice Management, Past Director of the American Professional Wound Care Association Board of Directors, and is a Past Chairman of the Board of the American Society of Podiatric Surgeons. Dr. Lehrman is also on the editorial advisory board of the journal WOUNDS.