Today's Wound Clinic - Spring 2008 - (Page 12)

inbusiness TABLE 3. Example: Skin Substitute Documentation Guidance • Medical record documentation maintained by the treating provider must substantiate the medical necessity of the services being billed. In addition, documentation that the service was performed must be included in the patient’s medical record. This information is normally found in the history and physical, office/progress notes, hospital notes, and/or procedure report. • Documentation must support the criteria for coverage as set forth in the “Indications and Limitations of Coverage and/or Medical Necessity” section of this policy, as well as, the appropriate diagnosis and response to treatment (ie, progress toward healing). • Documentation must support FDA labeling (where applicable), including the criteria, frequency, and acceptable duration of treatment for any skin substitute product billed • The primary physician, or diabetic’s managing physician, must be identified in the medical record if different from the physician managing the wound care Apligraf® / Dermagraft® For treatment of venous insufficiency ulcers, and diabetic foot ulcers the record must identify the duration of the ulcer’s presence with a description of the conservative treatment measures taken. The medical record must contain a description of the wound at baseline (prior to beginning conservative treatment) relative to size, location, stage, and presence of infection. The documentation must provide an updated description of the wound prior to Apligraf® or Dermagraft® application in terms of response to treatment (ie, ulcer measurement and progress toward healing). Following Apligraf® or Dermagraft®, application, continued documentation noting changes in the ulcer must be present. Additional applications must also be noted Integra® Documentation should support that Integra® is being used for post-excisional life-threatening full-thickness or deep partial-thickness burns where sufficient autograft is not available at the time of excision or not desirable due to the physiological condition of the patient OASIS® Wound Matrix Documentation must support that prior to treatment with OASIS, the wound/ulcer has been treated with intensive conventional non-surgical therapy and has not decreased in size and/or depth, and the wound/ulcer has not shown any indication (eg, granulation or progression towards closure) that improvement is likely. The documentation must show the patient is competent and/or has the support system required to participate in follow-up care associated with treatment of the wound with the product. OrCel™ For treatment of split thickness donor site wounds in burn patients the medical record must contain a description of the wound at baseline prior to beginning of treatment, relative to size, location, and presence of infection. The documentation must provide an updated description of the wound following the application of OrCel in terms of response to treatment (ie, progress toward healing) TABLE 4. Example: HBO Documentation Guidance • Hospital/Outpatient records should clearly document the history and physical exam, a reason for the treatment, and a report of the treatment. • Medical documentation must include: 1. An initial assessment, which will include a medical history detailing the condition requiring HBO. The medical history should list prior treatments and their results including antibiotic therapy and surgical interventions. This assessment should also contain information about adjunctive treatment currently being rendered; 2. Physician progress notes; 3. Any communication between physicians detailing past or future (proposed) treatments; 4. Positive gram-stain smear is required to support the diagnosis of gas gangrene; 5. Culture reports are required to confirm the diagnosis of Meleney’s ulcer; 6. Definitive radiographic evidence OR bone culture with sensitivity studies are required to confirm the diagnosis of osteomyelitis; 7. In the treatment of diabetic wounds of the lower extremities, that the patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes; the patient has a wound classified as Wagner grade III or higher; and the patient has failed an adequate course of standard wound therapy. 8. HBO treatment records describing the physical findings, the treatment rendered and the effect of the treatment upon the established goals for therapy. • Effective January 1, 2005, the following may be included in calculating the total number of 30-minute intervals billable under C1300: (1) time spent by the patient under 100% oxygen; (2) descent; (3) air breaks; and (4) ascent. This must be supported by the documentation. (Please note: A physician order for a 90-minute HBO treatment typically means that the physician desires that the patient be placed under 100% oxygen for 90 minutes. In order to safely achieve 100% oxygen for 90 minutes, additional time may be needed to provide for the descent, air breaks, and ascent. Therefore, the total number of billable 30-minute intervals would not be based solely on the amount of time noted on the physician order. In calculating how many 30-minute intervals to report, hospitals should take into consideration the time spent under pressure during descent, air breaks, and ascent. Additional units may be billed for sessions requiring at least 16 minutes of the next 30-minute interval. For example, 2 units of HCPCS code C1300 should be billed for a session in duration of between 46 and 75 minutes, while 3 units should be billed for a session in duration of between 76 and 105 minutes. Furthermore, 4 units of HCPCS code C1300 should be billed for a session in duration of between 106 and 135 minutes. HBO is typically prescribed for an average of 90 minutes, which hospitals should report using appropriate units of HCPCS code C1300 in order to properly bill for full body HBO therapy. In general, we do not expect that a physician order for 90 minutes of HBO therapy would exceed 4 billed units of HCPCS code C1300.) • Documentation for all services should be maintained on file to substantiate medical necessity for HBO treatment. Documentation must be submitted to Medicare upon request 12 Spring 2008 Today’s Wound Clinic

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Today's Wound Clinic - Spring 2008 Contents InTroduction InBusiness Documentation: The 30,000-Foot View Documentation: Clearing Up the Role of Compliance InTech InPhotography InFluence InStruction InNews InCentive Ad Index

Today's Wound Clinic - Spring 2008

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