RE:
f the coverage criteria described below are not met, the claim will be denied as not reasonable and necessary.
For an item to be covered by Medicare, a written signed and dated order must be received by the supplier before a claim is submitted. If the supplier bills for an item without first receiving the completed order, the item will be denied as not reasonable and necessary.
Surgical dressings are covered for as long as they are medically necessary. Dressings over a percutaneous catheter or tube (e.g., intravascular, epidural, nephrostomy, etc.) are covered as long as the catheter or tube remains in place and after removal until the wound heals. (Refer to Coding Guidelines in the associated Policy Article)
Surgical dressings used in conjunction with investigational wound healing therapy (e.g., platelet derived wound healing formula) may be covered if all applicable coverage criteria are met based on the number and type of surgical dressings that are appropriate to treat the wound if the investigational therapy were not being used.
When a wound cover with an adhesive border is being used, no other dressing is needed on top of it and additional tape is usually not required. Reasons for use of additional tape must be well documented. An adhesive border is usually more binding than that obtained with separate taping and is therefore indicated for use with wounds requiring less frequent dressing changes.
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B]Use of more than one type of wound filler or more than one type of wound cover in a single wound is rarely medically necessary[/B] and the reasons must be well documented. An exception is an alginate or other fiber gelling dressing wound cover or a saline, water, or hydrogel impregnated gauze dressing which might need an additional wound cover.
It may not be appropriate to use some combinations of a hydrating dressing on the same wound at the same time as an absorptive dressing (e.g., hydrogel and alginate).
Use of more than one type of hydrogel dressing (filler, cover, or impregnated gauze) on the same wound at the same time is not medically necessary.
Please take a look at A6010 and A6222 description. Not sure, but just my guess
Hello. Can I get some assistance with billing and coding for surgical wound dressing supplies. My provider has me billing wound supplies refills for our patients and I'm using
Hcpcs:
A4452,AW,A1
A6010,A1
A6222,A1
A6449,A1
ICD-10:
E11621
L97412
GATEWAY HEALTH MEDICAID REPLACEMENT PLAN paid on all codes except for Hcpcs A6010 on 9 patients for the reason below. I'm not sure what other service/procedure been adjudicated, since this is not for a post op which would require global service. Can someone give me some clarification on this. I hope this makes sense.
OA97: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF)
