Changes in Wound Care Coding Guidelines

Posted on in Billing/Reimbursement

There are always changes happening…the following will highlight some of them from January 2015 that affect the HME/DME world. Some of the links are highlighting what’s happening in certain jurisdictions. It’s important to keep in mind that even though you may not be in the jurisdiction that is having a review, you may be. Jurisdictions tend to follow suit with prepayment reviews.

Correct Coding - Surgical Dressings Containing Noncovered Components

DME MAC Joint Publication Some surgical dressings are produced containing noncovered components. This article reviews the coding guidelines for these items. The surgical dressings local coverage determination (LCD) related policy article (PA) states: "Products containing multiple materials are categorized according to the clinically predominant component (e.g., alginate, collagen, foam, gauze, hydrocolloid, hydrogel). Other multi-component wound dressings not containing these specified components may be classified as composite or specialty absorptive dressings if the definition of these categories has been met. Multi-component products may not be unbundled and billed as the separate components of the dressing." (PA Coding Guidelines) Historically, noncovered components have not been the majority constituent in multicomponent products. Recently, dressings where the noncovered components comprise the majority of the dressing have been identified. The coding guideline for multicomponent dressings states that the clinically predominant component will determine classification. Following this guideline:
  • Dressings only containing noncovered components, with or without a substrate, are coded as A9270 (Noncovered item or service)
  • Multicomponent dressings are coded based upon the clinically predominant component. For dressings that contain noncovered elements:
    • If the noncovered components are less than 50 percent of the dressing, coding is determined by the predominant covered component.
    • If the noncovered components comprise 50 percent or more of the dressing, the dressing is assigned to code A9270 (noncovered item or service).
Refer to the surgical dressing LCD and related PA for additional information about coding and coverage. For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center at 877-735-1326 during the hours of 8:30 a.m. to 4 p.m. Central Time, Monday through Friday, or email the PDAC by completing the DME PDAC Contact Form located on the PDAC website. Related Content