Wound Care (L28572)
Contractor Information
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Contractor Name Wisconsin Physicians Service Insurance Corporation |
Contractor Number 00951, 00952, 00953, 00954, 52280, 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402 |
Contractor Type Carrier - FI - MAC |
LCD Information
Document Information
L28572 LCD Title Wound Care Contractor's Determination Number GSURG-051 AMA CPT/ADA CDT Copyright Statement CPT only copyright 2002-2011 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association. |
Primary Geographic Jurisdiction
Oversight Region Original Determination Effective Date For services performed on or after 09/15/2009 Original Determination Ending Date Revision Effective Date For services performed on or after 05/01/2012 Revision Ending Date |
CMS National Coverage Policy
Title XVIII of the Social Security Act; Section 1862(a)(1)(A), (a)(1)(D)
Title XVIII of the Social Security Act; Section 1833(e).
Code of Federal Registry, Vol. 64. No 112/Tuesday, November 2, 1999/Rules and regulations page 59426.
CMS Publication 100-2, Medicare Benefit Policy Manual, Chapter 7-§40.1.2.8; Chapter 15, Section 22.02, 220.3, 230
CMS Publication 100-3, Medicare National Coverage Determination Manual, Chapter 1- Part 4, § 270 CMS Publication 100-4, Medicare Claims Processing Manual, Chapter 5, §10, 10.2, 20-20.5, 32, 40.2-40.5, 50
CMS Publication 100-8, Medicare Program Integrity Manual, Chapter 3, Section 3.4.1.1.1
CMS Publication 100-9, Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 5 Correct Coding Initiative
CMS Resident Assessment Instrument (RAI) Version 2.0, Chapter 3, Minimum Data Set (MDS) Items (L/M)
Title XVIII of the Social Security Act; Section 1833(e).
Code of Federal Registry, Vol. 64. No 112/Tuesday, November 2, 1999/Rules and regulations page 59426.
CMS Publication 100-2, Medicare Benefit Policy Manual, Chapter 7-§40.1.2.8; Chapter 15, Section 22.02, 220.3, 230
CMS Publication 100-3, Medicare National Coverage Determination Manual, Chapter 1- Part 4, § 270 CMS Publication 100-4, Medicare Claims Processing Manual, Chapter 5, §10, 10.2, 20-20.5, 32, 40.2-40.5, 50
CMS Publication 100-8, Medicare Program Integrity Manual, Chapter 3, Section 3.4.1.1.1
CMS Publication 100-9, Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 5 Correct Coding Initiative
CMS Resident Assessment Instrument (RAI) Version 2.0, Chapter 3, Minimum Data Set (MDS) Items (L/M)
Indications and Limitations of Coverage and/or Medical Necessity
For
the purposes of this LCD, wound care is defined as care of wounds that
are refractory to healing or have complicated healing cycles either
because of the nature of the wound itself or because of complicating
metabolic and/or physiological factors. This definition excludes
management of acute wounds, the care of wounds that normally heal by
primary intention such as clean, incised traumatic wounds, surgical
wounds that are closed primarily and other postoperative wound care not
separately payable during the surgical global period.
This policy does not address metabolically active human skin equivalent/substitute dressings, burns, skin cancer or hyperbaric oxygen therapy. (Note: see NCD 20.29 for Hyperbaric Oxygen Therapy). (Note: see GSURG-037 Application of Bioengineered Skin Substitutes and Skin Grafting - Part B Physician Services).
In order to be covered under Medicare per Title XVIII of the Social Security Act 1862(a)(1)(A) a service must be reasonable and necessary, which includes services which are safe and effective, furnished in the appropriate setting, and ordered and/or furnished by qualified personnel.
WOUND CARE should employ comprehensive wound management including appropriate control of complicating factors such as unrelieved pressure, infection, vascular and/or uncontrolled metabolic derangement, and/or nutritional deficiency in addition to appropriate debridement.
Medicare coverage for WOUND CARE on a continuing basis for a particular wound in a patient requires documentation in the patient's record that the wound is improving in response to the WOUND CARE being provided. It is not medically reasonable or necessary to continue a given type of WOUND CARE if evidence of wound improvement cannot be shown.
Evidence of improvement includes measurable changes (decreases) of some of the following:
Drainage
Inflammation
Swelling
Pain
Wound dimensions (diameter, depth)
Necrotic tissue/slough
Such evidence must be documented with each date of service provided. A wound that shows no improvement after 30 days requires a new approach which may include physician reassessment of underlying infection, metabolic, nutritional, or vascular problems inhibiting wound healing, or a new treatment.
Debridement is defined as the removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a traumatic or infected wound until surrounding healthy tissue is exposed. This LCD applies to debridement of localized areas such as wounds and ulcers. It does not apply to the removal of extensive eczematous or infected skin.
Debridements of the wound(s), if indicated, must be performed judiciously and at appropriate intervals. Medicare expects that with appropriate care, wound volume or surface dimension should decrease by at least 10 percent per month or wounds will demonstrate margin advancement of no less than 1 mm/week. Medicare expects the wound-care treatment plan to be modified in the event that appropriate healing is not achieved.
- Surgical debridement is excision or wide resection of all dead or devitalized tissue, possibly including excision of the viable wound margin. This is usually carried out in the operating theatre under anesthesia by a surgeon. It is frequently used for deep tissue infection, drainage of abscess or involved tendon sheath, or debridement of bone.
- Sharp debridement is the removal of dead or foreign material just above the level of viable tissue, and is performed in an office setting or at the patient's beside with or without the use of local anesthesia. Sharp debridement is less aggressive than surgical debridement but has the advantage of rapidly improving the healing conditions in the ulcer. These typically are the services of recurrent, superficial or repeated wound care.
- Blunt debridement is the removal of necrotic tissue by cleansing, scraping, chemical application or wet to dry dressing technique. It may also involve the cleaning and dressing of small or superficial lesions. Generally, this is not a skilled service and does not require the skills of a therapist, nurse, or enterostomal nurse.
- Enzymatic Debridement is debridement with topical enzymes is used when the necrotic substances to be removed from a wound are protein, fiber and collagen. The manufacturers' product insert contains indications, contraindications, precautions, dosage and administration guidelines; it would be the clinician's responsibility to comply with those guidelines.
At least ONE of the following conditions must be present and documented:
Selective debridement refers to the removal of specific, targeted areas of devitalized or necrotic tissue from a wound along the margin of viable tissue. Occasional bleeding and pain may occur. The routine application of a topical or local anesthetic does not elevate active wound care management to surgical debridement. Selective debridement includes selective removal of necrotic tissue by sharp dissection including scissors, scalpel, and forceps; and selective removal of necrotic tissue by high-pressure water jet. Selective debridement should only be done under the specific order of a physician.
High Pressure Water Jet / Pulsed Lavage: (non-immersion hydrotherapy) is an irrigation device, with or without pulsation used to provide a water jet to administer a shearing effect to loosen debris, within a wound. Some electric pulsatile irrigation devices include suction to remove debris from the wound after irrigation.
Debridement is used in the management and treatment of wounds or ulcers of the skin and underlying tissue. Providers should select a debridement method most appropriate to the type of wound, the amount of devitalized tissue, and the condition of the patient, the setting, and the provider's experience.
Debridements of the wound(s), if indicated, must be performed judiciously and at appropriate intervals. With the appropriate care, wound volume or surface dimension should decrease, once the size and depth of involvement and the extent of the undermining has been established. Interim outcomes should be established for the wound. These short-term goals help the clinician recognize wound improvement and serve to confirm the patient's wound-healing response. Medicare expects the wound-care treatment plan to be modified in the event that appropriate healing is not achieved.
Wounds or ulcers that are juxtaposition, involve contiguous areas, or on the same extremity are considered to reflect only one debridement service. Thus, multiple units of services for these should not be billed.
The original debridements typically are true surgical debridements. Repeated debridements are not the same service as the original debridement service. CPT codes 11043 and 11044 are codes that describe deep debridement of the muscle and bone. However, once the initial debridement of muscle and/or bone has been performed, there typically is no true necrotic muscle or bone remaining. Subsequent surgical debridement of muscle or bone is usually not necessary. If the medical record demonstrates complicating factors are present that contribute to further necrosis of muscle or bone, then subsequent staged surgical debridement of muscle and/or bone may be deemed necessary. The medical records should indicate the complicating factor(s) and the medical management used to control these complications. Staged debridement of muscle and/or bone greater than two additional debridements, should raise the question of whether the complicating factors are controlled adequately. Further debridement of muscle and/or bone may not be justified without adequate control of the underlying condition(s) leading to the complicating factors (i.e. infection, abscess, vascular insufficiency, nutritional compromise, etc.).
Just because there is a Stage IV ulcer, additional debridements are not necessarily bone and/or muscle debridements. The issue in billing for debridement services is not the stage of the wound; it is what procedure is actually being performed. A Stage III or Stage IV wound should be billed with the CPT code that describes the service rendered.
Care of chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers through use of Electrical Stimulation (ES) or Electromagnetic Therapy (ET) is covered under the limitations detailed in the National Coverage Determination (NCD) published in the CMS Internet-Only Manual (IOM) Pub. 100-03, National Coverage Determinations Manual, Chapter 1, Part 4, Section 270.1. Medicare would not expect ES/ET to be used as the initial treatment modality. The use of ES/ET will be covered as part of a therapy care plan only after standard wound therapy has been tried for at least 30 days and there are no measurable signs of healing. Medicare would not expect the treatment of a wound to include both ES and ET. If measurable signs of healing (e.g., decrease in wound size/surface or volume, decrease in amount of exudates and decrease in amount of necrotic tissue) have not been demonstrated within any 30-day period, ES/ET should be discontinued. Additionally, ES/ET must be discontinued when the wound demonstrates a 100 percent epithelialized wound bed. See the CMS policy for full text.
With appropriate management, it is expected that, in most cases, a wound will reach a state at which its care should be performed primarily by the patient and/or the patient's caregiver with periodic physician assessment and supervision. Wound care that can be performed by the patient or the patient's caregiver will be considered to be maintenance care.
The following services are not considered debridement:
- Mechanical Debridement: Wet-to-moist dressings may be used with wounds that have a high percentage of necrotic tissue. Hydrotherapy (immersion without jets) and wound irrigation (non-pulsated) are also forms of mechanical debridement used to remove necrotic tissue. They also should be used cautiously as maceration of surrounding tissue may hinder healing. Documentation must support the use of skilled personnel in order to be considered for coverage. While mechanical debridement is a valuable technique for healing ulcers, it does not qualify as debridement services (i.e. CPT 11042-11047 or 97597-97598)
- Removal of necrotic tissue by cleansing, scraping (other than by a scalpel or a curette), chemical application, and wet-to-dry dressing.
- Scraping the base of the wound bed to induce bleeding, following the removal of devitalized tissue, is not considered to be a separately billable service.
- Washing bacterial or fungal debris from lesions.
- Removal of secretions and coagulation serum from normal skin surrounding an ulcer.
- Dressing of small or superficial lesions.
- Paring or cutting of corns or non-plantar calluses. Skin breakdown under a dorsal corn that begins to heal when the corn is removed and the shoe pressure eliminated may be a small ulcer but generally does not require true debridement unless the breakdown extends significantly into the subcutaneous tissue.
- Incision and drainage of abscess including paronychia, trimming or debridement of mycotic nails, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. Providers should report these procedures, when they represent covered, reasonable and necessary services, using appropriate CPT or HCPCS codes.
- Removing a collar of callus (hyperkeratotic tissue) around an ulcer is not debridement of skin or necrotic tissue and should not be billed as debridement unless additional partial for full skin thickness tissue directly deep to the callus is removed as well.
Negative Pressure Wound Therapy (97605-97606):
Negative Pressure Wound Therapy (NPWT) involves the application of controlled or intermittent negative pressure to a properly dressed wound cavity. Suction (negative pressure) is applied under airtight wound dressings to promote the healing of open wounds resistant to prior treatments.
Non-Covered Modalities:
The following Non-Selective Debridement Techniques are not separately billable
Maintenance wound care is not covered as debridement services.
CPT code 97597 and 97598 require the presence of devitalized tissue (necrotic cellular material). Secretions of any consistency do not meet this definition. The mere removal of secretions (cleansing of a wound) does not represent a debridement service
CPT code 97602 has been assigned a status indicator "B" in the Medicare Physician Fee Schedule Database (MPFSDB), meaning that it is not separately payable under Medicare.
The use of CPT codes 11042-11047 is not appropriate for the following services: washing bacterial or fungal debris from lesions, paring or cutting of corns or calluses, incision and drainage of abscess including paronychia, trimming or debridement of nails, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. Providers should report these procedures, when they represent covered, reasonable and necessary services, using the CPT or CPT codes that describe the service supplied.
Local infiltration, such as a metatarsal/digital block or topical anesthesia are included in the reimbursement for debridement services and are not separately payable. Anesthesia administered by or incident to the provider performing the debridement procedure is not separately payable.
Active wound care may not be billed by a Medicare Part B provider when a home health agency (HHA) is seeing the patient as that service is considered to be included in the HHA care.
This policy does not address metabolically active human skin equivalent/substitute dressings, burns, skin cancer or hyperbaric oxygen therapy. (Note: see NCD 20.29 for Hyperbaric Oxygen Therapy). (Note: see GSURG-037 Application of Bioengineered Skin Substitutes and Skin Grafting - Part B Physician Services).
In order to be covered under Medicare per Title XVIII of the Social Security Act 1862(a)(1)(A) a service must be reasonable and necessary, which includes services which are safe and effective, furnished in the appropriate setting, and ordered and/or furnished by qualified personnel.
WOUND CARE should employ comprehensive wound management including appropriate control of complicating factors such as unrelieved pressure, infection, vascular and/or uncontrolled metabolic derangement, and/or nutritional deficiency in addition to appropriate debridement.
Medicare coverage for WOUND CARE on a continuing basis for a particular wound in a patient requires documentation in the patient's record that the wound is improving in response to the WOUND CARE being provided. It is not medically reasonable or necessary to continue a given type of WOUND CARE if evidence of wound improvement cannot be shown.
Evidence of improvement includes measurable changes (decreases) of some of the following:
Drainage
Inflammation
Swelling
Pain
Wound dimensions (diameter, depth)
Necrotic tissue/slough
Such evidence must be documented with each date of service provided. A wound that shows no improvement after 30 days requires a new approach which may include physician reassessment of underlying infection, metabolic, nutritional, or vascular problems inhibiting wound healing, or a new treatment.
Debridement is defined as the removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a traumatic or infected wound until surrounding healthy tissue is exposed. This LCD applies to debridement of localized areas such as wounds and ulcers. It does not apply to the removal of extensive eczematous or infected skin.
Debridements of the wound(s), if indicated, must be performed judiciously and at appropriate intervals. Medicare expects that with appropriate care, wound volume or surface dimension should decrease by at least 10 percent per month or wounds will demonstrate margin advancement of no less than 1 mm/week. Medicare expects the wound-care treatment plan to be modified in the event that appropriate healing is not achieved.
- Surgical debridement is excision or wide resection of all dead or devitalized tissue, possibly including excision of the viable wound margin. This is usually carried out in the operating theatre under anesthesia by a surgeon. It is frequently used for deep tissue infection, drainage of abscess or involved tendon sheath, or debridement of bone.
- Sharp debridement is the removal of dead or foreign material just above the level of viable tissue, and is performed in an office setting or at the patient's beside with or without the use of local anesthesia. Sharp debridement is less aggressive than surgical debridement but has the advantage of rapidly improving the healing conditions in the ulcer. These typically are the services of recurrent, superficial or repeated wound care.
- Blunt debridement is the removal of necrotic tissue by cleansing, scraping, chemical application or wet to dry dressing technique. It may also involve the cleaning and dressing of small or superficial lesions. Generally, this is not a skilled service and does not require the skills of a therapist, nurse, or enterostomal nurse.
- Enzymatic Debridement is debridement with topical enzymes is used when the necrotic substances to be removed from a wound are protein, fiber and collagen. The manufacturers' product insert contains indications, contraindications, precautions, dosage and administration guidelines; it would be the clinician's responsibility to comply with those guidelines.
At least ONE of the following conditions must be present and documented:
- Pressure ulcers, Stage III or IV;
- Venous or arterial insufficiency ulcers;
- Dehisced wounds or wounds with exposed hardware or bone;
- Neuropathic ulcers
- Complications of surgically-created or traumatic wound where accelerated granulation therapy is necessary which cannot be achieved by other available topical wound treatment.
Selective debridement refers to the removal of specific, targeted areas of devitalized or necrotic tissue from a wound along the margin of viable tissue. Occasional bleeding and pain may occur. The routine application of a topical or local anesthetic does not elevate active wound care management to surgical debridement. Selective debridement includes selective removal of necrotic tissue by sharp dissection including scissors, scalpel, and forceps; and selective removal of necrotic tissue by high-pressure water jet. Selective debridement should only be done under the specific order of a physician.
High Pressure Water Jet / Pulsed Lavage: (non-immersion hydrotherapy) is an irrigation device, with or without pulsation used to provide a water jet to administer a shearing effect to loosen debris, within a wound. Some electric pulsatile irrigation devices include suction to remove debris from the wound after irrigation.
Debridement is used in the management and treatment of wounds or ulcers of the skin and underlying tissue. Providers should select a debridement method most appropriate to the type of wound, the amount of devitalized tissue, and the condition of the patient, the setting, and the provider's experience.
Debridements of the wound(s), if indicated, must be performed judiciously and at appropriate intervals. With the appropriate care, wound volume or surface dimension should decrease, once the size and depth of involvement and the extent of the undermining has been established. Interim outcomes should be established for the wound. These short-term goals help the clinician recognize wound improvement and serve to confirm the patient's wound-healing response. Medicare expects the wound-care treatment plan to be modified in the event that appropriate healing is not achieved.
Wounds or ulcers that are juxtaposition, involve contiguous areas, or on the same extremity are considered to reflect only one debridement service. Thus, multiple units of services for these should not be billed.
The original debridements typically are true surgical debridements. Repeated debridements are not the same service as the original debridement service. CPT codes 11043 and 11044 are codes that describe deep debridement of the muscle and bone. However, once the initial debridement of muscle and/or bone has been performed, there typically is no true necrotic muscle or bone remaining. Subsequent surgical debridement of muscle or bone is usually not necessary. If the medical record demonstrates complicating factors are present that contribute to further necrosis of muscle or bone, then subsequent staged surgical debridement of muscle and/or bone may be deemed necessary. The medical records should indicate the complicating factor(s) and the medical management used to control these complications. Staged debridement of muscle and/or bone greater than two additional debridements, should raise the question of whether the complicating factors are controlled adequately. Further debridement of muscle and/or bone may not be justified without adequate control of the underlying condition(s) leading to the complicating factors (i.e. infection, abscess, vascular insufficiency, nutritional compromise, etc.).
Just because there is a Stage IV ulcer, additional debridements are not necessarily bone and/or muscle debridements. The issue in billing for debridement services is not the stage of the wound; it is what procedure is actually being performed. A Stage III or Stage IV wound should be billed with the CPT code that describes the service rendered.
Care of chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers through use of Electrical Stimulation (ES) or Electromagnetic Therapy (ET) is covered under the limitations detailed in the National Coverage Determination (NCD) published in the CMS Internet-Only Manual (IOM) Pub. 100-03, National Coverage Determinations Manual, Chapter 1, Part 4, Section 270.1. Medicare would not expect ES/ET to be used as the initial treatment modality. The use of ES/ET will be covered as part of a therapy care plan only after standard wound therapy has been tried for at least 30 days and there are no measurable signs of healing. Medicare would not expect the treatment of a wound to include both ES and ET. If measurable signs of healing (e.g., decrease in wound size/surface or volume, decrease in amount of exudates and decrease in amount of necrotic tissue) have not been demonstrated within any 30-day period, ES/ET should be discontinued. Additionally, ES/ET must be discontinued when the wound demonstrates a 100 percent epithelialized wound bed. See the CMS policy for full text.
With appropriate management, it is expected that, in most cases, a wound will reach a state at which its care should be performed primarily by the patient and/or the patient's caregiver with periodic physician assessment and supervision. Wound care that can be performed by the patient or the patient's caregiver will be considered to be maintenance care.
The following services are not considered debridement:
- Mechanical Debridement: Wet-to-moist dressings may be used with wounds that have a high percentage of necrotic tissue. Hydrotherapy (immersion without jets) and wound irrigation (non-pulsated) are also forms of mechanical debridement used to remove necrotic tissue. They also should be used cautiously as maceration of surrounding tissue may hinder healing. Documentation must support the use of skilled personnel in order to be considered for coverage. While mechanical debridement is a valuable technique for healing ulcers, it does not qualify as debridement services (i.e. CPT 11042-11047 or 97597-97598)
- Removal of necrotic tissue by cleansing, scraping (other than by a scalpel or a curette), chemical application, and wet-to-dry dressing.
- Scraping the base of the wound bed to induce bleeding, following the removal of devitalized tissue, is not considered to be a separately billable service.
- Washing bacterial or fungal debris from lesions.
- Removal of secretions and coagulation serum from normal skin surrounding an ulcer.
- Dressing of small or superficial lesions.
- Paring or cutting of corns or non-plantar calluses. Skin breakdown under a dorsal corn that begins to heal when the corn is removed and the shoe pressure eliminated may be a small ulcer but generally does not require true debridement unless the breakdown extends significantly into the subcutaneous tissue.
- Incision and drainage of abscess including paronychia, trimming or debridement of mycotic nails, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. Providers should report these procedures, when they represent covered, reasonable and necessary services, using appropriate CPT or HCPCS codes.
- Removing a collar of callus (hyperkeratotic tissue) around an ulcer is not debridement of skin or necrotic tissue and should not be billed as debridement unless additional partial for full skin thickness tissue directly deep to the callus is removed as well.
Negative Pressure Wound Therapy (97605-97606):
Negative Pressure Wound Therapy (NPWT) involves the application of controlled or intermittent negative pressure to a properly dressed wound cavity. Suction (negative pressure) is applied under airtight wound dressings to promote the healing of open wounds resistant to prior treatments.
Non-Covered Modalities:
The following Non-Selective Debridement Techniques are not separately billable
- Chemical: necrotic tissue is digested by exogenous proteases in the wound (Enzymes, hypertonic saline). Debridement with topical enzymes is used when the necrotic substances to be removed from a wound are protein, fiber and collagen.
- Whirlpool: Whirlpool is considered for coverage if medically necessary for the healing of the wound. Generally, whirlpool treatments do not require the skills of a therapist to perform. The skills of a therapist may be required to perform an accurate assessment of the patient and the wound to assure the medial necessity of the whirlpool for the specific wound type. Documentation must support the use of skilled personnel in order to be considered for coverage. The skills, knowledge and judgment of a qualified therapist might be required when the patient's condition is complicated by circulatory deficiency, areas of desensitization, complex open wounds, and fractures. Immersion in the whirlpool to facilitate removal of a dressing would not be considered a skilled treatment modality and would not be billable. Note that whirlpool is bundled into 97597 and 97598 and is not separately billable unless applied to a different body part that the wound being treated.
- *Ultrasonic Wound Debridement: (CPT code 0183T) is a system that uses continuous low frequency ultrasonic energy to atomize a liquid and deliver continuous low frequency ultrasound to the wound bed. This cleansing method is not considered a significantly separately payable coverable service by Medicare. Therefore Mist Therapy or other similar products (CPT code 0183T) is included in the payment for the E&M or other concurrent wound care services. Mist Therapy TM System 5.0 Wound Treatment Device is not covered as a separate service.
- Massage: Massage has not been proven to be effective in wound care and will not be considered for coverage.
- Ultra-sound deep thermal modality (97035): The effectiveness of this modality has not been proven in wound care; and therefore will not be considered for coverage.
- Infrared (97026): see CMS Pub100-3, Chapter 1, Part 4, Section 270.6
- Noncontact Normothermic Wound Therapy (NNWT): There is insufficient scientific or clinical evidence to consider this device as reasonable and necessary for the treatment of wounds within the meaning of SSA 1862(a)(1)(A), and will not be covered by Medicare. (Pub 100-3, Chp 1, Part 4, Section 270.2)
- Blood-Derived Products for Chronic Non-Healing Wounds. (Pub 100-3, Chp 1, Part 4, Section 270.3)
- Dressing changes not separately payable.
- Phototherapy-ultraviolet (97028) used to promote healing of skin disorders will not be considered for coverage for decubitus ulcers.
- Trimming of callous or fibrinous material from the margins of an ulcer or from feet with no ulcer present is not considered debridement by this Contractor and would not be considered for coverage.
- Nutritional counseling.
- Documentation time
- Administrative tasks
Maintenance wound care is not covered as debridement services.
CPT code 97597 and 97598 require the presence of devitalized tissue (necrotic cellular material). Secretions of any consistency do not meet this definition. The mere removal of secretions (cleansing of a wound) does not represent a debridement service
CPT code 97602 has been assigned a status indicator "B" in the Medicare Physician Fee Schedule Database (MPFSDB), meaning that it is not separately payable under Medicare.
The use of CPT codes 11042-11047 is not appropriate for the following services: washing bacterial or fungal debris from lesions, paring or cutting of corns or calluses, incision and drainage of abscess including paronychia, trimming or debridement of nails, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. Providers should report these procedures, when they represent covered, reasonable and necessary services, using the CPT or CPT codes that describe the service supplied.
Local infiltration, such as a metatarsal/digital block or topical anesthesia are included in the reimbursement for debridement services and are not separately payable. Anesthesia administered by or incident to the provider performing the debridement procedure is not separately payable.
Active wound care may not be billed by a Medicare Part B provider when a home health agency (HHA) is seeing the patient as that service is considered to be included in the HHA care.
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 022x | Skilled Nursing - Inpatient (Medicare Part B only) |
| 023x | Skilled Nursing - Outpatient |
| 071x | Clinic - Rural Health |
| 073x | Clinic - Freestanding |
| 075x | Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF) |
| 083x | Ambulatory Surgery Center |
| 085x | Critical Access Hospital |
Revenue Codes:
CPT/HCPCS Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
| 0360 | Operating Room Services - General Classification |
| 042X | Physical Therapy - General Classification |
| 043X | Occupational Therapy - General Classification |
| 045X | Emergency Room - General Classification |
| 049X | Ambulatory Surgical Care - General Classification |
| 051X | Clinic - General Classification |
| 052X | Free-Standing Clinic - General Classification |
| 0761 | Specialty Services - Treatment Room |
| 0977 | Professional Fees - Physical Therapy |
| 0978 | Professional Fees - Occupational Therapy |
| 11042 | DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS |
| 11043 | DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS |
| 11044 | DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS |
| 11045 | DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 11046 | DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 11047 | DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 97597 | DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS |
| 97598 | DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 97602 | REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, WET-TO-MOIST DRESSINGS, ENZYMATIC, ABRASION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION |
| 97605 | NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS |
| 97606 | NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS |
| G0281 | ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR CHRONIC STAGE III AND STAGE IV PRESSURE ULCERS, ARTERIAL ULCERS, DIABETIC ULCERS, AND VENOUS STATSIS ULCERS NOT DEMONSTRATING MEASURABLE SIGNS OF HEALING AFTER 30 DAYS OF CONVENTIONAL CARE, AS PART OF A THERAPY PLAN OF CARE |
| G0329 | ELECTROMAGNETIC THERAPY, TO ONE OR MORE AREAS FOR CHRONIC STAGE III AND STAGE IV PRESSURE ULCERS, ARTERIAL ULCERS, DIABETIC ULCERS AND VENOUS STASIS ULCERS NOT DEMONSTRATING MEASURABLE SIGNS OF HEALING AFTER 30 DAYS OF CONVENTIONAL CARE AS PART OF A THERAPY PLAN OF CARE |
ICD-9 Codes that Support Medical Necessity
Medicare is establishing the following limited coverage for CPT/HCPCS codes 11042 - 11047, 97597, 97598, 97602, 97605 and 97606.
| 040.0 | GAS GANGRENE |
| 440.23 - 440.24 | ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH ULCERATION - ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH GANGRENE |
| 443.9 | PERIPHERAL VASCULAR DISEASE UNSPECIFIED |
| 454.0 - 454.2 | VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER - VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER AND INFLAMMATION |
| 459.10 | POSTPHLEBETIC SYNDROME WITHOUT COMPLICATIONS |
| 459.11 | POSTPHLEBETIC SYNDROME WITH ULCER |
| 459.81 | VENOUS (PERIPHERAL) INSUFFICIENCY UNSPECIFIED |
| 680.0 - 680.9 | CARBUNCLE AND FURUNCLE OF FACE - CARBUNCLE AND FURUNCLE OF UNSPECIFIED SITE |
| 681.00 - 681.9 | UNSPECIFIED CELLULITIS AND ABSCESS OF FINGER - CELLULITIS AND ABSCESS OF UNSPECIFIED DIGIT |
| 682.0 - 682.9 | CELLULITIS AND ABSCESS OF FACE - CELLULITIS AND ABSCESS OF UNSPECIFIED SITES |
| 686.09 | OTHER PYODERMA |
| 686.8 | OTHER SPECIFIED LOCAL INFECTIONS OF SKIN AND SUBCUTANEOUS TISSUE |
| 686.9 | UNSPECIFIED LOCAL INFECTION OF SKIN AND SUBCUTANEOUS TISSUE |
| 707.00 - 707.9 | PRESSURE ULCER, UNSPECIFIED SITE - CHRONIC ULCER OF UNSPECIFIED SITE |
| 709.4 | FOREIGN BODY GRANULOMA OF SKIN AND SUBCUTANEOUS TISSUE |
| 728.86 | NECROTIZING FASCIITIS |
| 729.6 | RESIDUAL FOREIGN BODY IN SOFT TISSUE |
| 730.10 - 730.19 | CHRONIC OSTEOMYELITIS SITE UNSPECIFIED - CHRONIC OSTEOMYELITIS INVOLVING MULTIPLE SITES |
| 730.20 - 730.29 | UNSPECIFIED OSTEOMYELITIS SITE UNSPECIFIED - UNSPECIFIED OSTEOMYELITIS INVOLVING MULTIPLE SITES |
| 785.4 | GANGRENE |
| 872.00 - 872.01 | OPEN WOUND OF EXTERNAL EAR UNSPECIFIED SITE UNCOMPLICATED - OPEN WOUND OF AURICLE UNCOMPLICATED |
| 872.8 | OPEN WOUND OF EAR PART UNSPECIFIED WITHOUT COMPLICATION |
| 872.9 | OPEN WOUND OF EAR PART UNSPECIFIED COMPLICATED |
| 873.0 - 873.1 | OPEN WOUND OF SCALP WITHOUT COMPLICATION - OPEN WOUND OF SCALP COMPLICATED |
| 873.20 | OPEN WOUND OF NOSE UNSPECIFIED SITE UNCOMPLICATED |
| 873.21 | OPEN WOUND OF NASAL SEPTUM UNCOMPLICATED |
| 873.40 - 873.59 | OPEN WOUND OF FACE UNSPECIFIED SITE UNCOMPLICATED - OPEN WOUND OF OTHER AND MULTIPLE SITES COMPLICATED |
| 873.8 | OTHER AND UNSPECIFIED OPEN WOUND OF HEAD WITHOUT COMPLICATION |
| 875.0 - 875.1 | OPEN WOUND OF CHEST (WALL) WITHOUT COMPLICATION - OPEN WOUND OF CHEST (WALL) COMPLICATED |
| 876.0 - 876.1 | OPEN WOUND OF BACK WITHOUT COMPLICATION - OPEN WOUND OF BACK COMPLICATED |
| 877.0 - 877.1 | OPEN WOUND OF BUTTOCK WITHOUT COMPLICATION - OPEN WOUND OF BUTTOCK COMPLICATED |
| 878.0 - 878.9 | OPEN WOUND OF PENIS WITHOUT COMPLICATION - OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF GENITAL ORGANS COMPLICATED |
| 879.0 - 879.9 | OPEN WOUND OF BREAST WITHOUT COMPLICATION - OPEN WOUND(S) (MULTIPLE) OF UNSPECIFIED SITE(S) COMPLICATED |
| 880.00 - 887.7 | OPEN WOUND OF SHOULDER REGION WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED |
| 890.0 - 897.7 | OPEN WOUND OF HIP AND THIGH WITHOUT COMPLICATION - TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED |
| 906.0 | LATE EFFECT OF OPEN WOUND OF HEAD NECK AND TRUNK |
| 906.1 | LATE EFFECT OF OPEN WOUND OF EXTREMITIES WITHOUT TENDON INJURY |
| 906.2 | LATE EFFECT OF SUPERFICIAL INJURY |
| 919.0 - 919.9 | ABRASION OR FRICTION BURN OF OTHER MULTIPLE AND UNSPECIFIED SITES WITHOUT INFECTION - OTHER AND UNSPECIFIED SUPERFICIAL INJURY OF OTHER MULTIPLE AND UNSPECIFIED SITES INFECTED |
| 958.3 | POSTTRAUMATIC WOUND INFECTION NOT ELSEWHERE CLASSIFIED |
| 991.6 | HYPOTHERMIA |
| 997.60 | UNSPECIFIED LATE COMPLICATION OF AMPUTATION STUMP |
| 997.62 | INFECTION (CHRONIC) OF AMPUTATION STUMP |
| 997.69 | OTHER LATE AMPUTATION STUMP COMPLICATION |
| 998.30 | DISRUPTION OF WOUND, UNSPECIFIED |
| 998.31 | DISRUPTION OF INTERNAL OPERATION (SURGICAL) WOUND |
| 998.32 | DISRUPTION OF EXTERNAL OPERATION (SURGICAL) WOUND |
| 998.33 | DISRUPTION OF TRAUMATIC INJURY WOUND REPAIR |
| 998.51 | INFECTED POSTOPERATIVE SEROMA |
| 998.59 | OTHER POSTOPERATIVE INFECTION |
| 998.6 | PERSISTENT POSTOPERATIVE FISTULA NOT ELSEWHERE CLASSIFIED |
| 998.83 | NON-HEALING SURGICAL WOUND |
Covered
| 707.01 - 707.07 | PRESSURE ULCER, ELBOW - PRESSURE ULCER, HEEL |
| 707.09 | PRESSURE ULCER, OTHER SITE |
| 707.10 - 707.15 | UNSPECIFIED ULCER OF LOWER LIMB - ULCER OF OTHER PART OF FOOT |
| 707.19 | ULCER OF OTHER PART OF LOWER LIMB |
| 707.8 - 707.9 | CHRONIC ULCER OF OTHER SPECIFIED SITES - CHRONIC ULCER OF UNSPECIFIED SITE |
Diagnoses that Support Medical Necessity
See above
ICD-9 Codes that DO NOT Support Medical Necessity
Codes not listed above
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
General Information
The medical record
must include a Certified Plan of Care containing treatment goals and
physician follow-up. The record must document complicating factors for
wound healing as well as measures taken to control complicating factors
when debridement is part of the plan. Appropriate modification of
treatment plans, when necessitated by failure of wounds to heal, must be
demonstrated.
The patient's medical record must contain clearly documented evidence of the progress of the wound's response to treatment at each visit. This documentation must include, at a minimum:
- Current wound volume (surface dimensions and depth).
- Presence (and extent of) or absence of obvious signs of infection.
- Presence (and extent of) or absence of necrotic, devitalized or non-viable tissue.
- Other material in the wound that is expected to inhibit healing or promote adjacent tissue breakdown.
When debridements are reported, the debridement procedure notes should demonstrate tissue removal (i.e., skin, full or partial thickness; subcutaneous tissue; muscle and/or bone), the method used to debride (i.e., hydrostatic, sharp, abrasion, etc.) and the character of the wound (including dimensions, description of necrotic material present, description of tissue removed, degree of epithelialization, etc.) before and after debridement.
Appropriate evaluation and management of contributory medical conditions or other factors affecting the course of wound healing (such as nutritional status or other predisposing conditions) should be addressed in the record at intervals consistent with the nature of the condition or factor.
Photographic documentation of wounds immediately before and after debridement is recommended for prolonged or repetitive debridement services (especially those that exceed five debridements per wound). Photographic documentation is required for payment of more than five extensive debridements (beyond skin and subcutaneous tissue) per wound.
When ES or ET is used, wounds must be evaluated periodically (no less than every 30 days) by the treating provider. Clear documentation of this must be present in the patient's medical record.
Active debridement must be performed under a treatment plan as any other therapy service outlining specific goals, duration, frequency, modalities, an anticipated endpoint, and other pertinent factors as they may apply. Departure from this plan must be documented.
Documentation for debridement exceeding Utilization Guidelines must include a complete description of the wound, progress towards healing, complications that have delayed healing and a projected number of additional treatments necessary.
When hydrotherapy (whirlpool) is billed by a physical therapist with CPT codes 97597 or 97598, the documentation must reflect that the skill set of a physical therapist was required to perform this service in the given situation.
When hydrotherapy (whirlpool) is billed by a therapist with CPT codes 97597 or 97598, the documentation must reflect the clinical reasoning why hydrotherapy was a necessary component of the total wound care treatment. Separate billing of whirlpool (97022) is not permitted with 97597-97598 unless it is provided for a different body part that the wound care treatment.
Wound care provided by Physical therapist, for both in and out patient wound care the following is expected:
- Physician order(s) for physical therapy (PT)/wound care services
- Initial evaluation of PT/wound care services
- Wound characteristics such as diameter, depth, color, presence of exudates or necrotic tissue
- Previous wound care services administered to include date and modalities of treatment
- Plan of treatment for PT/wound care services
- Weekly progress notes to include current wound status, measurements (including size and depth), and the treatment provided
- Description of instrument used for selective or sharp debridement (i.e. forceps, scalpel, scissors, tweezers, high-pressure water jet, etc.)
- Treatment grid/log reflecting PT HCPCS billed
- Certification/recertification for PT/wound care services
- Detailed itemization for any 27X (Supplies) or 62X (Supplies) charges
- Actual minutes provided to support each timed service/HCPCS provided
Note: If patient is continued from one billing period to another, include initial evaluation and progress notes/summary of wound progress prior to the service dates billed.
The patient's medical record must contain clearly documented evidence of the progress of the wound's response to treatment at each visit. This documentation must include, at a minimum:
- Current wound volume (surface dimensions and depth).
- Presence (and extent of) or absence of obvious signs of infection.
- Presence (and extent of) or absence of necrotic, devitalized or non-viable tissue.
- Other material in the wound that is expected to inhibit healing or promote adjacent tissue breakdown.
When debridements are reported, the debridement procedure notes should demonstrate tissue removal (i.e., skin, full or partial thickness; subcutaneous tissue; muscle and/or bone), the method used to debride (i.e., hydrostatic, sharp, abrasion, etc.) and the character of the wound (including dimensions, description of necrotic material present, description of tissue removed, degree of epithelialization, etc.) before and after debridement.
Appropriate evaluation and management of contributory medical conditions or other factors affecting the course of wound healing (such as nutritional status or other predisposing conditions) should be addressed in the record at intervals consistent with the nature of the condition or factor.
Photographic documentation of wounds immediately before and after debridement is recommended for prolonged or repetitive debridement services (especially those that exceed five debridements per wound). Photographic documentation is required for payment of more than five extensive debridements (beyond skin and subcutaneous tissue) per wound.
When ES or ET is used, wounds must be evaluated periodically (no less than every 30 days) by the treating provider. Clear documentation of this must be present in the patient's medical record.
Active debridement must be performed under a treatment plan as any other therapy service outlining specific goals, duration, frequency, modalities, an anticipated endpoint, and other pertinent factors as they may apply. Departure from this plan must be documented.
Documentation for debridement exceeding Utilization Guidelines must include a complete description of the wound, progress towards healing, complications that have delayed healing and a projected number of additional treatments necessary.
When hydrotherapy (whirlpool) is billed by a physical therapist with CPT codes 97597 or 97598, the documentation must reflect that the skill set of a physical therapist was required to perform this service in the given situation.
When hydrotherapy (whirlpool) is billed by a therapist with CPT codes 97597 or 97598, the documentation must reflect the clinical reasoning why hydrotherapy was a necessary component of the total wound care treatment. Separate billing of whirlpool (97022) is not permitted with 97597-97598 unless it is provided for a different body part that the wound care treatment.
Wound care provided by Physical therapist, for both in and out patient wound care the following is expected:
- Physician order(s) for physical therapy (PT)/wound care services
- Initial evaluation of PT/wound care services
- Wound characteristics such as diameter, depth, color, presence of exudates or necrotic tissue
- Previous wound care services administered to include date and modalities of treatment
- Plan of treatment for PT/wound care services
- Weekly progress notes to include current wound status, measurements (including size and depth), and the treatment provided
- Description of instrument used for selective or sharp debridement (i.e. forceps, scalpel, scissors, tweezers, high-pressure water jet, etc.)
- Treatment grid/log reflecting PT HCPCS billed
- Certification/recertification for PT/wound care services
- Detailed itemization for any 27X (Supplies) or 62X (Supplies) charges
- Actual minutes provided to support each timed service/HCPCS provided
Note: If patient is continued from one billing period to another, include initial evaluation and progress notes/summary of wound progress prior to the service dates billed.
Appendices
Utilization Guidelines
Payment for
prolonged, repetitive debridement services requires adequate
documentation of complicating circumstances that reasonably necessitated
additional services. It is expected only one debridement involving
true removal of muscle and/or bone to be required for management of most
wounds within a 12 (twelve) month period.
Sources of Information and Basis for Decision
Agency for Health
Care Policy and Research, Clinical Practice Guide, Number 15,
Publication No. 95-0652, December 1994.
American Physical Therapy Association, Guide to Physical Therapist Practice, Second Edition, 2001.
CMS RAI Version 2.0 Manual, Chapter 3, MDS Items (L/M).
Healthcare Common Procedure Coding System (HCPCS), Level II, 2008.
Medicare Coverage Policy Decisions, Warm-Up Wound Therapy a/k/a Noncontact Normothermic Wound Therapy, HCFA.gov/coverage.
Physical Agents in Rehabilitation, From Research to Practice; Michelle H. Cameron, Section 2, page 204.
Advances in Skin and Wound Care; Vol 17, No.2, Debridement: Controlling the Necrotic/Cellular Burden
Pulsavac III Wound Debridement System, Zimmer Inc, Wound protocol Information.
Wound Care Information Network, www.medicaledu.com.
Mist Therapy System marketing information
KCI The Clinical Advantage. (May 2007) V.A.C. Therapy Clinical Guidelines: A reference source for clinicians.
Almodovar L.F., Canas A., Candas P.P., Hernandez M.C. (2005). Vacuum-assisted therapy with a
handcrafted system for the treatment of wound infection after median sternotomy. Interactive
Cardio Vascular and Thoracic Surgery 2005; 4:412-414 Retrieved on February 7, 2007 from
http://proquest.waldenu.edu
Anderson I., (February 28, 2006) Debridement methods in wound care. Nursing Standard Volume
20 Issue 24 pages 65, 5 pgs. Retrieved on March 9, 2007 from http://proquest.waldenu.edu
Blunt J. (2001) wound cleansing Ritualistic or research-based practice. Online Journal Nursing standard. Harrow on-the-hill: September 19-September 25, 2001, Vol. 16, Iss.1; pg. 33, 4 pg. Retrieved February 1, 2007 from http://proguest.waldenu.edu/pqdweb?index
Burke T.J. (2006).The Effect of Monochromatic Infrared Energy on Sensation in Subjects with Diabetic Peripheral Neuropathy: A Double-Blind, Placebo-Controlled Study. Diabetes Care 29:1186 A response to Clifft et al. Retrieved on March 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/29/51186
Bryant R. A, Nix D. P., (2007). Acute & chronic Wounds Current Management Concepts: Third Edition, Chapter 10 Wound Debridement. Mosby St Louis Missouri.
Bryant R. A, Nix D. P., (2007). Acute & chronic Wounds Current Management Concepts: Third Edition, Chapter 19, Principles of Wound Management. Mosby St Louis Missouri.
Carson S.N., Overall K. Lee-Jahshan S., Travis E. (March 2004) Vaccum-Assisted Closure Used for Healing Chronic Wounds and Skin Grafts in the Lower Extremities. Ostomy Wound Management Volume 50 Issue 3 pages 52-58 Retrieved on March 15, 2007 from http://www.o-wm.com/article/2386
Clifft J. K., Newton T. S., Bush A. J. (2005). The Effect of Monochromatic Infrared Energy on Sensation in Patients with Diabetic Peripheral Neuropathy. Online Journal American Diabetes
Association. Diabetes Care (28) 2896-2900, 2005. Retrieved January 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/28/12/2896
Clifft J.K., Kasser R.J., Newton T.S.S, Bush A.J., (2006). The Effect of Monochromatic Infrared Energy on Sensation in Subjects with Diabetic Peripheral Neuropathy: A Double-Blind, Placebo-Controlled Study. Diabetes Care 29:1186-1187. A response to Burke Retrieved on March 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/29/5/1186-a
Clifft J. K., Newton T. S., Bush A. J. (2005). The Effect of Monochromatic Infrared Energy on Sensation in Patients with Diabetic Peripheral Neuropathy: A Double-Blind, Placebo-Controlled Study Diabetes. Online Journal American Diabetes Association. Diabetes Care (28) 2896-2900, 2005. Retrieved January 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/28/12/2896
Leonard D.R., Farooqi M.H., Myers S., (2004). Restoration of Sensation, Reduced Pain, and Improved Balance in Subjects with Diabetic Peripheral Neuropathy. Diabetes Care 27:168-172 Retrieved on March 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/27/1/168?maxtoshow=HITS=10hits
The Guide to Physical Therapist Practice; Second Edition 2001, The Journal of the American Physical Therapy Association January 2001 Volume 81 Number 1
The Guide to Occupational Therapy Practice, The American Occupational Therapy Association, Inc, (1999).
Cowan K., Teague L., Sue S.C., Mahoney J.L. (April 4, 2005). Vacuum-Assisted Wound Closure of Deep Sternal Infections in High-Risk Patients after Cardiac Surgery. The Annals of Thoracic Surgery (80) p. 2205-2212 Retrieved on February 6, 2007 from http://proquest.waldenu.edu
Department of Health and Human Services. (2006). Food and Drug Administration Regarding Kinetic Concepts, Inc Re: K062227
Ennis, W. J., Valdes, W., Gainer, M., Meneses, P., (2006) Evaluation of clinical effectiveness of mist ultrasound therapy for the healing of chronic wounds. Advances in skin & wound care. Wound Care journal October 2006, Retrieved March 1, 2007 from www.woundcarejournal.com
Ennis, W.J., Formann, P., Mozen N., Massey, J., Conner-Kerr, T., Meneses, P., Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multicenter study. (2005) Ostomy/Wound Management, 2005; 51 (8); 24-39. Retrieved March 1, 2007 from
www.o-wm.com/article/4532 - 67k
Fleck T.M., Fleck M., Moidl R., Czerny M., Koller R., Giovanoli P., Hiesmayer M.J., Zimpfer D., Wolner E., Grabenwoger M., (2002) The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. The Annals of Thoracic Surgery 2002;74:1596-1600 Retrieved on March 3, 2007 from http://proquest.waldenu.edu
Lefevre S. D., Aronson N., (2004). Wound-healing technologies: low-level laser and vacuum-assisted closure: December 2004. Evidence report/technology assessment. Agency for healthcare research and quality. Number 11. Retrieved March 1, 2007 from www.ahrq.gov
Luedtke-Hoffmann K. A., Schafer S. D., (2000) Pulsed lavage in Wound cleansing: Physical therapy March 2005 Vol. 80, No. 3, pp. 292-300 Retrieved March 1, 2007 from http://www.ptjournal.org/cgi/content/full/80/3/292
McCulloch J. (2004). The integumentary system-repair and management: an overview. Alexandrai: February 2004. Vol. 12, Iss. 2; pg. 52, 18 pgs. Retrieved February 1, 2007 from http://proquest.waldenu.edu/pqdweb?
Milne C.T. (2003). Wound, Ostomy, and Continence Nursing Secrets. Questions and Answers Reveal the Secrets to Successful WOC Care.
Morris S., Brueilly E., Hanzelka H., (January 2007). Negative Pressure Wound Therapy Achieved by Vaccum-Assisted Closure: Evaluating the Assumptions. Ostomy Wound Management. Volume 53 Issue 1 pages 52-57 Retrieved on March 15. 2007 from http://www.o-wm.com/article/6655
Rakel A. Ekoe J.M. (2006) Canadian Diabets Association Technical Review: The Diabetic Foot and Hyperbaric Oxygen Therapy. Canadian Journal of Diabetes, 2006; 30 (4);pages 411-421.
Rayman G, Rayman A, Baker N.R., Jurgeviciene. (2005). Sustained silver-releasing dressing in the treatment of diabetic foot. Online Journal British Journal of Nursing. London January 27-February 9, 2005. Vol. 14, Iss. 2; pg. 109, 5 pg. Retrieved February 1, 2007 from http://proquest.waldenu.edu/pqdweb?index
Sibbald G. R., Mahoney J., Therapy Canadian Consensus Group. (November 2003). A consensus Report on the Use of Vaccum-Assisted Closure in Chronic, Difficult-to-Heal Wounds. Ostomy Wound Management Volume 49 issue 11 pages: 52 66 Retrieved on March 15, 2007 from http://www.o-wm.com/article/2209
Technology Evaluation Center Evidence-based Practice Center. (2004) Wound-Healing Technologies: Low-level Laser and Vaccum-Assisted Closure. Number 11, Chicago, Illinois.
Technology Assessment (March 8, 2005) Usual Care in the Management of Chronic Wounds: A Review of the Recent Literature. Rockville, Maryland
Wolvos T., (November 2004). Wound Installation-The Next Step in Negative Pressure Wound Therapy. Lessons Learned from Initial Experiences. Ostomy Wound Management Volume 50 Issue 11 pages 56-66. Retrieved on March 15, 2007 from http://www.o-wm.com/article/3261
Zamboni W.A., (January 2003) Hyperbaric oxygen and wound healing. Clinics in Plastic Surgery Volume 30 Issue 1 pages 67-75. Retrieved on February 12, 2007 from http://www,plasticsurgery.theclinics.com/article/PIIS009412980200688/fulltext
Acute & Chronic wounds Current Management Concepts, Third Addition, Chapter 10 Wound Debridement, Chapter 19 Principles in Wound Management, Mosby Elsevier
Copyright 2007, 200, 1992.
Boulton, A.J.M., Kirsner, R.S., and Vileikyte, L. (July 2004) Neuropathic Diabetic Foot Ulcers. The New England Journal of Medicine, Volume 351:48-55, Number 1. Retrieved February 20, 2008 from http://content.nejm.org/cgi/content/full/351/11/787.
Huttenlocher, A., Horwitz, A.R. (January 2007) Wound Healing with Electric Potential. The New England Journal of Medicine, Volume 356:303-304, Number 3. Retrieved February 20, 2008 from http://content.nejm.org/cgi/content/full/356/3/303.
Journal of the American Academy of Dermatology. Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings. Volume 58, Issue 2(February 2008) Copyright 2008 American Academy of Dermatology, Inc. Retrieved on February 20, 2008 from http://www.mdconsult.com/das/article/body/88398184-3/jorg
Other Contractor policies: Wisconsin Physicians Service; National Government Services; Highmark Medicare Services; Cahaba Government Benefit Administrators; TrailBlazer Health Enterprises; Riverbend Government Benefits Administrator; Palmetto Government Benefit Administrators; CIGNA Government Services.
Sumpio, B.E. (September 2000) Foot Ulcers. The New England Journal of Medicine, Volume 343:787-793, Number 11. Retrieved February 20, 2008 from http://content.nejm.org/cgi/content/full/343/11/787
Singer, A.J., Clark, R.A.F., ( September 1999) Cutaneous Wound Healing. The New England Journal of Medicine, Volume 341: 738-746, Number 10. Retrieved February 20, 2008 from http://content.nejm.org/cgi/content/full/341/10/738.
Stillman, R.M., (January 2007) Wound Care. Emedicine from WebMD, Last Updated January 4, 2007. Retrieved February 20, 2008 from http://www.emedicine.com/MED/topic2754.htm.
Swartz, M.N.(February 2004) Cellulitis. The New England Journal of Medicine, Volume 350:904-912. Retrieved on February 20, 2008 from http://content.nejm.org/cgi/content/full/350/9/904.
Wound Care Information Network, http://www.medicaledu.com.
The Clinical Relevance of Microbiology in Acute and Chronic Wounds. McGuckin M, Goldman R, Bolton L, Salcido R. Adv Skin Wound Care. 2003 Jan-Feb;16(1):12-23;
Vanscheidt W, Sadjadi Z, Lillieborg S. EMLA Anaesthetic Cream For Sharp Leg Ulcer Debridement: A Review of the Clinical Evidence For Analgesic Efficacy and Tolerability. Eur J Dermatol. 2001 Mar-Apr;11(2):90-6
Leaper, David Sharp Technique for Wound Debridement.http: //www.worldwidewounds.com/2002/december/Leaper/Sharp-Debridement.html
American Physical Therapy Association, Guide to Physical Therapist Practice, Second Edition, 2001.
CMS RAI Version 2.0 Manual, Chapter 3, MDS Items (L/M).
Healthcare Common Procedure Coding System (HCPCS), Level II, 2008.
Medicare Coverage Policy Decisions, Warm-Up Wound Therapy a/k/a Noncontact Normothermic Wound Therapy, HCFA.gov/coverage.
Physical Agents in Rehabilitation, From Research to Practice; Michelle H. Cameron, Section 2, page 204.
Advances in Skin and Wound Care; Vol 17, No.2, Debridement: Controlling the Necrotic/Cellular Burden
Pulsavac III Wound Debridement System, Zimmer Inc, Wound protocol Information.
Wound Care Information Network, www.medicaledu.com.
Mist Therapy System marketing information
KCI The Clinical Advantage. (May 2007) V.A.C. Therapy Clinical Guidelines: A reference source for clinicians.
Almodovar L.F., Canas A., Candas P.P., Hernandez M.C. (2005). Vacuum-assisted therapy with a
handcrafted system for the treatment of wound infection after median sternotomy. Interactive
Cardio Vascular and Thoracic Surgery 2005; 4:412-414 Retrieved on February 7, 2007 from
http://proquest.waldenu.edu
Anderson I., (February 28, 2006) Debridement methods in wound care. Nursing Standard Volume
20 Issue 24 pages 65, 5 pgs. Retrieved on March 9, 2007 from http://proquest.waldenu.edu
Blunt J. (2001) wound cleansing Ritualistic or research-based practice. Online Journal Nursing standard. Harrow on-the-hill: September 19-September 25, 2001, Vol. 16, Iss.1; pg. 33, 4 pg. Retrieved February 1, 2007 from http://proguest.waldenu.edu/pqdweb?index
Burke T.J. (2006).The Effect of Monochromatic Infrared Energy on Sensation in Subjects with Diabetic Peripheral Neuropathy: A Double-Blind, Placebo-Controlled Study. Diabetes Care 29:1186 A response to Clifft et al. Retrieved on March 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/29/51186
Bryant R. A, Nix D. P., (2007). Acute & chronic Wounds Current Management Concepts: Third Edition, Chapter 10 Wound Debridement. Mosby St Louis Missouri.
Bryant R. A, Nix D. P., (2007). Acute & chronic Wounds Current Management Concepts: Third Edition, Chapter 19, Principles of Wound Management. Mosby St Louis Missouri.
Carson S.N., Overall K. Lee-Jahshan S., Travis E. (March 2004) Vaccum-Assisted Closure Used for Healing Chronic Wounds and Skin Grafts in the Lower Extremities. Ostomy Wound Management Volume 50 Issue 3 pages 52-58 Retrieved on March 15, 2007 from http://www.o-wm.com/article/2386
Clifft J. K., Newton T. S., Bush A. J. (2005). The Effect of Monochromatic Infrared Energy on Sensation in Patients with Diabetic Peripheral Neuropathy. Online Journal American Diabetes
Association. Diabetes Care (28) 2896-2900, 2005. Retrieved January 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/28/12/2896
Clifft J.K., Kasser R.J., Newton T.S.S, Bush A.J., (2006). The Effect of Monochromatic Infrared Energy on Sensation in Subjects with Diabetic Peripheral Neuropathy: A Double-Blind, Placebo-Controlled Study. Diabetes Care 29:1186-1187. A response to Burke Retrieved on March 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/29/5/1186-a
Clifft J. K., Newton T. S., Bush A. J. (2005). The Effect of Monochromatic Infrared Energy on Sensation in Patients with Diabetic Peripheral Neuropathy: A Double-Blind, Placebo-Controlled Study Diabetes. Online Journal American Diabetes Association. Diabetes Care (28) 2896-2900, 2005. Retrieved January 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/28/12/2896
Leonard D.R., Farooqi M.H., Myers S., (2004). Restoration of Sensation, Reduced Pain, and Improved Balance in Subjects with Diabetic Peripheral Neuropathy. Diabetes Care 27:168-172 Retrieved on March 15, 2007 from http://care.diabetesjournals.org/cgi/content/full/27/1/168?maxtoshow=HITS=10hits
The Guide to Physical Therapist Practice; Second Edition 2001, The Journal of the American Physical Therapy Association January 2001 Volume 81 Number 1
The Guide to Occupational Therapy Practice, The American Occupational Therapy Association, Inc, (1999).
Cowan K., Teague L., Sue S.C., Mahoney J.L. (April 4, 2005). Vacuum-Assisted Wound Closure of Deep Sternal Infections in High-Risk Patients after Cardiac Surgery. The Annals of Thoracic Surgery (80) p. 2205-2212 Retrieved on February 6, 2007 from http://proquest.waldenu.edu
Department of Health and Human Services. (2006). Food and Drug Administration Regarding Kinetic Concepts, Inc Re: K062227
Ennis, W. J., Valdes, W., Gainer, M., Meneses, P., (2006) Evaluation of clinical effectiveness of mist ultrasound therapy for the healing of chronic wounds. Advances in skin & wound care. Wound Care journal October 2006, Retrieved March 1, 2007 from www.woundcarejournal.com
Ennis, W.J., Formann, P., Mozen N., Massey, J., Conner-Kerr, T., Meneses, P., Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multicenter study. (2005) Ostomy/Wound Management, 2005; 51 (8); 24-39. Retrieved March 1, 2007 from
www.o-wm.com/article/4532 - 67k
Fleck T.M., Fleck M., Moidl R., Czerny M., Koller R., Giovanoli P., Hiesmayer M.J., Zimpfer D., Wolner E., Grabenwoger M., (2002) The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. The Annals of Thoracic Surgery 2002;74:1596-1600 Retrieved on March 3, 2007 from http://proquest.waldenu.edu
Lefevre S. D., Aronson N., (2004). Wound-healing technologies: low-level laser and vacuum-assisted closure: December 2004. Evidence report/technology assessment. Agency for healthcare research and quality. Number 11. Retrieved March 1, 2007 from www.ahrq.gov
Luedtke-Hoffmann K. A., Schafer S. D., (2000) Pulsed lavage in Wound cleansing: Physical therapy March 2005 Vol. 80, No. 3, pp. 292-300 Retrieved March 1, 2007 from http://www.ptjournal.org/cgi/content/full/80/3/292
McCulloch J. (2004). The integumentary system-repair and management: an overview. Alexandrai: February 2004. Vol. 12, Iss. 2; pg. 52, 18 pgs. Retrieved February 1, 2007 from http://proquest.waldenu.edu/pqdweb?
Milne C.T. (2003). Wound, Ostomy, and Continence Nursing Secrets. Questions and Answers Reveal the Secrets to Successful WOC Care.
Morris S., Brueilly E., Hanzelka H., (January 2007). Negative Pressure Wound Therapy Achieved by Vaccum-Assisted Closure: Evaluating the Assumptions. Ostomy Wound Management. Volume 53 Issue 1 pages 52-57 Retrieved on March 15. 2007 from http://www.o-wm.com/article/6655
Rakel A. Ekoe J.M. (2006) Canadian Diabets Association Technical Review: The Diabetic Foot and Hyperbaric Oxygen Therapy. Canadian Journal of Diabetes, 2006; 30 (4);pages 411-421.
Rayman G, Rayman A, Baker N.R., Jurgeviciene. (2005). Sustained silver-releasing dressing in the treatment of diabetic foot. Online Journal British Journal of Nursing. London January 27-February 9, 2005. Vol. 14, Iss. 2; pg. 109, 5 pg. Retrieved February 1, 2007 from http://proquest.waldenu.edu/pqdweb?index
Sibbald G. R., Mahoney J., Therapy Canadian Consensus Group. (November 2003). A consensus Report on the Use of Vaccum-Assisted Closure in Chronic, Difficult-to-Heal Wounds. Ostomy Wound Management Volume 49 issue 11 pages: 52 66 Retrieved on March 15, 2007 from http://www.o-wm.com/article/2209
Technology Evaluation Center Evidence-based Practice Center. (2004) Wound-Healing Technologies: Low-level Laser and Vaccum-Assisted Closure. Number 11, Chicago, Illinois.
Technology Assessment (March 8, 2005) Usual Care in the Management of Chronic Wounds: A Review of the Recent Literature. Rockville, Maryland
Wolvos T., (November 2004). Wound Installation-The Next Step in Negative Pressure Wound Therapy. Lessons Learned from Initial Experiences. Ostomy Wound Management Volume 50 Issue 11 pages 56-66. Retrieved on March 15, 2007 from http://www.o-wm.com/article/3261
Zamboni W.A., (January 2003) Hyperbaric oxygen and wound healing. Clinics in Plastic Surgery Volume 30 Issue 1 pages 67-75. Retrieved on February 12, 2007 from http://www,plasticsurgery.theclinics.com/article/PIIS009412980200688/fulltext
Acute & Chronic wounds Current Management Concepts, Third Addition, Chapter 10 Wound Debridement, Chapter 19 Principles in Wound Management, Mosby Elsevier
Copyright 2007, 200, 1992.
Boulton, A.J.M., Kirsner, R.S., and Vileikyte, L. (July 2004) Neuropathic Diabetic Foot Ulcers. The New England Journal of Medicine, Volume 351:48-55, Number 1. Retrieved February 20, 2008 from http://content.nejm.org/cgi/content/full/351/11/787.
Huttenlocher, A., Horwitz, A.R. (January 2007) Wound Healing with Electric Potential. The New England Journal of Medicine, Volume 356:303-304, Number 3. Retrieved February 20, 2008 from http://content.nejm.org/cgi/content/full/356/3/303.
Journal of the American Academy of Dermatology. Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings. Volume 58, Issue 2(February 2008) Copyright 2008 American Academy of Dermatology, Inc. Retrieved on February 20, 2008 from http://www.mdconsult.com/das/article/body/88398184-3/jorg
Other Contractor policies: Wisconsin Physicians Service; National Government Services; Highmark Medicare Services; Cahaba Government Benefit Administrators; TrailBlazer Health Enterprises; Riverbend Government Benefits Administrator; Palmetto Government Benefit Administrators; CIGNA Government Services.
Sumpio, B.E. (September 2000) Foot Ulcers. The New England Journal of Medicine, Volume 343:787-793, Number 11. Retrieved February 20, 2008 from http://content.nejm.org/cgi/content/full/343/11/787
Singer, A.J., Clark, R.A.F., ( September 1999) Cutaneous Wound Healing. The New England Journal of Medicine, Volume 341: 738-746, Number 10. Retrieved February 20, 2008 from http://content.nejm.org/cgi/content/full/341/10/738.
Stillman, R.M., (January 2007) Wound Care. Emedicine from WebMD, Last Updated January 4, 2007. Retrieved February 20, 2008 from http://www.emedicine.com/MED/topic2754.htm.
Swartz, M.N.(February 2004) Cellulitis. The New England Journal of Medicine, Volume 350:904-912. Retrieved on February 20, 2008 from http://content.nejm.org/cgi/content/full/350/9/904.
Wound Care Information Network, http://www.medicaledu.com.
The Clinical Relevance of Microbiology in Acute and Chronic Wounds. McGuckin M, Goldman R, Bolton L, Salcido R. Adv Skin Wound Care. 2003 Jan-Feb;16(1):12-23;
Vanscheidt W, Sadjadi Z, Lillieborg S. EMLA Anaesthetic Cream For Sharp Leg Ulcer Debridement: A Review of the Clinical Evidence For Analgesic Efficacy and Tolerability. Eur J Dermatol. 2001 Mar-Apr;11(2):90-6
Leaper, David Sharp Technique for Wound Debridement.http: //www.worldwidewounds.com/2002/december/Leaper/Sharp-Debridement.html
Advisory Committee Meeting Notes
Meeting Date:
Wisconsin 09/26/2008
Illinois 09/17/2008
Michigan 09/24/2008
Minnesota 09/11/2008
Iowa 10/16/2008
Kansas 10/16/2008
Missouri 10/17/2008
Nebraska 10/16/2008
Open Meeting Date
08/13/2008
This policy does not reflect the sole opinion of the contractor or the Contractor Medical Director(s). Although the final decision rests with the contractor, this policy was developed in cooperation with the Carrier Advisory Committee(s), which include representatives of various medical specialty societies.
Wisconsin 09/26/2008
Illinois 09/17/2008
Michigan 09/24/2008
Minnesota 09/11/2008
Iowa 10/16/2008
Kansas 10/16/2008
Missouri 10/17/2008
Nebraska 10/16/2008
Open Meeting Date
08/13/2008
This policy does not reflect the sole opinion of the contractor or the Contractor Medical Director(s). Although the final decision rests with the contractor, this policy was developed in cooperation with the Carrier Advisory Committee(s), which include representatives of various medical specialty societies.
Start Date of Comment Period
10/18/2008
End Date of Comment Period
12/03/2008
Start Date of Notice Period
02/01/2011
Revision History Number
X
Revision History Explanation
05/01/2010, five,
corrected typo CPT code changed from 11401 to the correct 11041
04/01/2010, ICD-9 codes 998.30 and 998.33 inadvertently omitted from final version of LCD. These two codes have been added to the LCD, effective 09/15/2009
*10/01/2009, two, corrected typo, ICD-9 873.30 changed to 873.0, not a valid code no need to publish typo
08/28/2009 Updated multiple typos. Coverage not affected-not an active policy until 9/15/09.
Removed contractor number 05392 E MO. This number is being joined with W MO to include all of MO under one contractor number effective 8/01/2009.
08/01/2009, one, new LCD replaces L15700 Wound Care, L26653 GSURG-551 Chronic Wound Care that are retired as of 9/15/2009;
added MAC J5 states
8/10/2009 - The description for Revenue code 0761 was changed
3/7/2010 - The description for Bill Type Code 73 was changed
04/19/2010-In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 22 was changed
8/1/2010 - The description for Bill Type Code 23 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 75 was changed
8/1/2010 - The description for Bill Type Code 83 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0420 was changed
8/1/2010 - The description for Revenue code 0421 was changed
8/1/2010 - The description for Revenue code 0422 was changed
8/1/2010 - The description for Revenue code 0423 was changed
8/1/2010 - The description for Revenue code 0424 was changed
8/1/2010 - The description for Revenue code 0429 was changed
8/1/2010 - The description for Revenue code 0430 was changed
8/1/2010 - The description for Revenue code 0431 was changed
8/1/2010 - The description for Revenue code 0432 was changed
8/1/2010 - The description for Revenue code 0433 was changed
8/1/2010 - The description for Revenue code 0434 was changed
8/1/2010 - The description for Revenue code 0439 was changed
8/1/2010 - The description for Revenue code 0450 was changed
8/1/2010 - The description for Revenue code 0451 was changed
8/1/2010 - The description for Revenue code 0452 was changed
8/1/2010 - The description for Revenue code 0456 was changed
8/1/2010 - The description for Revenue code 0459 was changed
8/1/2010 - The description for Revenue code 0490 was changed
8/1/2010 - The description for Revenue code 0499 was changed
8/1/2010 - The description for Revenue code 0510 was changed
8/1/2010 - The description for Revenue code 0511 was changed
8/1/2010 - The description for Revenue code 0512 was changed
8/1/2010 - The description for Revenue code 0513 was changed
8/1/2010 - The description for Revenue code 0514 was changed
8/1/2010 - The description for Revenue code 0515 was changed
8/1/2010 - The description for Revenue code 0516 was changed
8/1/2010 - The description for Revenue code 0517 was changed
8/1/2010 - The description for Revenue code 0519 was changed
8/1/2010 - The description for Revenue code 0520 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0523 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0526 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0529 was changed
8/1/2010 - The description for Revenue code 0761 was changed
8/1/2010 - The description for Revenue code 0977 was changed
8/1/2010 - The description for Revenue code 0978 was changed
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
11042 descriptor was changed in Group 1
11043 descriptor was changed in Group 1
11044 descriptor was changed in Group 1
97597 descriptor was changed in Group 1
97598 descriptor was changed in Group 1
97605 descriptor was changed in Group 1
97606 descriptor was changed in Group 1
11/21/2010 - The following CPT/HCPCS codes were deleted:
11040 was deleted from Group 1
11041 was deleted from Group 1
*01/01/2011, 2011 HCPCS update, corrected spelling of metatarsal
02/01/2011, added ICD-9 codes 459.10, 459.11, 459.81 claims submitted on and after 01/01/2011
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
12/01/2011, annual review, no changes;
05/01/2012, ICD-9 758.4 removed - typo, changed to ICD-9 785.4;
04/01/2010, ICD-9 codes 998.30 and 998.33 inadvertently omitted from final version of LCD. These two codes have been added to the LCD, effective 09/15/2009
*10/01/2009, two, corrected typo, ICD-9 873.30 changed to 873.0, not a valid code no need to publish typo
08/28/2009 Updated multiple typos. Coverage not affected-not an active policy until 9/15/09.
Removed contractor number 05392 E MO. This number is being joined with W MO to include all of MO under one contractor number effective 8/01/2009.
08/01/2009, one, new LCD replaces L15700 Wound Care, L26653 GSURG-551 Chronic Wound Care that are retired as of 9/15/2009;
added MAC J5 states
8/10/2009 - The description for Revenue code 0761 was changed
3/7/2010 - The description for Bill Type Code 73 was changed
04/19/2010-In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 22 was changed
8/1/2010 - The description for Bill Type Code 23 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 75 was changed
8/1/2010 - The description for Bill Type Code 83 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0420 was changed
8/1/2010 - The description for Revenue code 0421 was changed
8/1/2010 - The description for Revenue code 0422 was changed
8/1/2010 - The description for Revenue code 0423 was changed
8/1/2010 - The description for Revenue code 0424 was changed
8/1/2010 - The description for Revenue code 0429 was changed
8/1/2010 - The description for Revenue code 0430 was changed
8/1/2010 - The description for Revenue code 0431 was changed
8/1/2010 - The description for Revenue code 0432 was changed
8/1/2010 - The description for Revenue code 0433 was changed
8/1/2010 - The description for Revenue code 0434 was changed
8/1/2010 - The description for Revenue code 0439 was changed
8/1/2010 - The description for Revenue code 0450 was changed
8/1/2010 - The description for Revenue code 0451 was changed
8/1/2010 - The description for Revenue code 0452 was changed
8/1/2010 - The description for Revenue code 0456 was changed
8/1/2010 - The description for Revenue code 0459 was changed
8/1/2010 - The description for Revenue code 0490 was changed
8/1/2010 - The description for Revenue code 0499 was changed
8/1/2010 - The description for Revenue code 0510 was changed
8/1/2010 - The description for Revenue code 0511 was changed
8/1/2010 - The description for Revenue code 0512 was changed
8/1/2010 - The description for Revenue code 0513 was changed
8/1/2010 - The description for Revenue code 0514 was changed
8/1/2010 - The description for Revenue code 0515 was changed
8/1/2010 - The description for Revenue code 0516 was changed
8/1/2010 - The description for Revenue code 0517 was changed
8/1/2010 - The description for Revenue code 0519 was changed
8/1/2010 - The description for Revenue code 0520 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0523 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0526 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0529 was changed
8/1/2010 - The description for Revenue code 0761 was changed
8/1/2010 - The description for Revenue code 0977 was changed
8/1/2010 - The description for Revenue code 0978 was changed
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
11042 descriptor was changed in Group 1
11043 descriptor was changed in Group 1
11044 descriptor was changed in Group 1
97597 descriptor was changed in Group 1
97598 descriptor was changed in Group 1
97605 descriptor was changed in Group 1
97606 descriptor was changed in Group 1
11/21/2010 - The following CPT/HCPCS codes were deleted:
11040 was deleted from Group 1
11041 was deleted from Group 1
*01/01/2011, 2011 HCPCS update, corrected spelling of metatarsal
02/01/2011, added ICD-9 codes 459.10, 459.11, 459.81 claims submitted on and after 01/01/2011
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
12/01/2011, annual review, no changes;
05/01/2012, ICD-9 758.4 removed - typo, changed to ICD-9 785.4;
Reason for Change
Typographical Correction
Related Documents
This LCD has no Related Documents.
LCD Attachments
Billing & Coding Guidelines 12/1/11 (PDF - 17 KB )
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