Today's Wound Clinic - Winter 2008 - (Page 13) inBusiness Pertinent Text Unna boots, four-layer compression dressings, or multilayered sustained, graduated high compression bandage systems are only covered for ulcers or inflammatory conditions of the lower extremity. If ulcers are present on both extremities, an Unna boot may be applied to both on the same date of service, but must be billed with modified -50 appended to the CPT code. It is appropriate to bill 29580 for the application of four-layer compression dressings (ie, PROFORE*) Data analysis and probe reviews have revealed that many providers are utilizing CPT code 29580 to bill for wound dressings following debridement procedures. Under the OPPS payment methodology, supplies are packaged into the facility fee (ie, the debridement of evaluation and management (E&M) code); unless a specifically assigned HCPCS code is available. The record reviews indicate that many providers are applying a compression wrap (PROFORE*) following wound care. PROFORE* consists of prepackaged dressing supplies and separate payment may not be made for these supplies. The charges for the Unna boots in these cases were denied as services not documented (5PDOC). It was noted that the wound care services were medically necessary services but payment was denied due to incorrect coding. Providers are entitled to receive reimbursement for the medically necessary services rendered in the wound care setting. If medically necessary services are rendered as described above, but the treatment does not involve application of an actual Unna boot, the provider should bill an E&M service (level determined by the intensity of services and resources used) to capture a facility fee payment. The charges for the supplies should be billed under Revenue 270; these charges (compression wraps, and so on) would be packaged into the reimbursement for the E&M service. If a HCPC code with a status indicator of “S” or “T” procedure (debridement) is rendered, followed by wrapping the extremity, the appropriate code should be billed with the supply charges under Revenue 270. The supplies are packaged into the facility fee (in this case, the debridement charge). As with any service provided to the beneficiary, the service must be medically necessary and the documentation must support the service reported. The CPT 29580 should be reported only when an actual Unna boot is applied. An Unna boot is a multilayered, mediation impregnated bandage that may be made with zinc oxide, calamine lotion, glycerin, and/or gelatin, which is wrapped from the toes to just below the knee. The bandage then dries and hardens, and an elastic bandage may be wrapped over it. The Unna boot service must not occur on a daily basis, but approximately every 5 to 7 days. The American Hospital Association (AHA) Coding Clinic for HCPS, Volume 7, Number 1, 2007, Ask the Editor, question #6 verifies that multilayered high graduated compression dressings such as PROFORE* and DYNAFLEX† are reported appropriately with CPT code 29580. All Unna boot applications may be performed by a nurse or non-physician provider when incident to physician services and performed within the scope of their licensure. Riverbend expects the documentation to include the physician order as well a description of the Unna boot application and patient education. Prepackaged dressings are not separately reportable. They are packaged into the facility fee for other services performed on the same date. Unna Boot o CPT 29580 – (Strapping, Unna Boot) is to be used for fractures and dislocations; therefore not with wound care. o An Unna boot as well as other dressings such as Kling‡ and PROFORE* may be used as a dressing for wound care and will be covered as a supply; however, they should not be billed with CPT 29580. o The method of application (primary or secondary dressing) will be left to the discretion of the provider. The use of the Splinting, Strapping, and Casting codes (CPT 29065-29580) are not covered for application of dressings or bandages. Unna boot is considered a supply. Today’s Wound Clinic Winter 2008 13
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