Ever since the Payment Strategies column was established, this author has needed to repeatedly address one subject in particular: the Surgical Dressing Local Coverage Determination (LCD) L338311 and its attached Policy Article A54563.2 Although these documents have been in existence for several decades, many wound and ulcer management physicians and other qualified healthcare professionals (QHPs) do not know about them and do not incorporate the utilization guidelines into their selection of surgical dressings for Medicare Part B-covered patients to use at home.
This oversight has caught the attention of various Medicare contractors who audit claims for primary and secondary surgical dressings ordered by physicians/QHPs and provided by durable medical equipment (DME) suppliers. The pre-payment audits have resulted in a large percentage of denied claims and the postpayment audits have resulted in significant repayments. The DME Medicare Administrative Contractors (MACs) provide free webinars to educate physicians/QHPs about their obligations to appropriately assess wounds/ulcers, document the medical necessity for both the primary and secondary dressings, and order combinations of primary and secondary dressings that align with all the LCD and the Policy Article guidelines.
All physicians and QHPs who order surgical dressings for Medicare Part B-covered patients to use at home should download, study, and follow all the Surgical Dressing LCD and Policy Article guidelines to ensure that the DME suppliers can compliantly provide the surgical dressings ordered for their patients. The LCD and Policy Article are two of the most content-heavy coverage and coding guidelines that are pertinent to wound and ulcer management.
To help physicians/QHPs appreciate the many surgical dressing coverage and documentation guidelines that must be followed, this author prepared a self-test that addresses a small sample of the guidelines (Table). Check your answers on page 335 or online (Supplemental Table, http://links.lww.com/NSW/A141). If physicians/QHPs do not score 100% on the following test, this author recommends that they read, or re-read, the Surgical Dressing LCD and Policy Article before ordering more surgical dressings for Medicare Part B-covered patients to use at home.
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