In Case You Missed It: The Surgical Dressing Policy, Still Alive and Well

  In the May 2011 issue of Today’s Wound Clinic, Dot Weir and Pamela Scarborough had an article on the Surgical Dressing Policy. Because it fits with this issue as well, below are some key points, but you can also access the entire article at https://www.todayswoundclinic.com/surgical-dressing-policy-still-alive-and-well.

Some Highlights of the Article Include:

  • The Surgical Dressing Policy is alive and well! Though we usually think of Medicare Part B with the policy, many private insurance and managed care companies have similar policies and access to products. It takes some legwork and usually several phone calls to get to the right source.

  • Surgical dressings are covered when they are medically necessary for the treatment of a wound caused by, or treated by, a surgical procedure or when debridement of a wound is medically necessary.

  • Debridement of a wound may be any type of debridement (examples given are not all-inclusive): surgical (eg, sharp instrument or laser), mechanical (eg, irrigation or wet-to-dry dressings), chemical (eg, topical application of enzymes), or autolytic (eg, application of occlusive dressings to an open wound).
    o Dressings used for mechanical debridement, to cover chemical debriding agents, or to cover wounds to allow for autolytic debridement are covered although the agents themselves are non-covered.

  • Surgical dressings include both primary dressings (ie, therapeutic or protective coverings applied directly to wounds or lesions either on the skin or caused by an opening to the skin) and secondary dressings (ie, materials that serve a therapeutic or protective function and that are needed to secure a primary dressing).

  • Refer to the original article for a full chart related to the utilization guidelines related to the policy, but these are some basic “rules” to consider:
    o When a decision is made on a plan of care for the patient, there must be a written order in the patient’s medical record as to need for the dressings, the type, amount and frequency.
    o The patient must sign the order form acknowledging that they are aware that this order is being placed for them, that there may be a co-payment necessary, and that their protected health information will be shared to place the order.
    o Consider the fact that wounds are dynamic and change, particularly in the early part of the treatment, and document the duration of time that the dressings will be needed when ordering so that an appropriate amount will be sent and not wasted.
    o Compression stockings are also allowable under the surgical dressing policy. The allowable is for one pair per month, allowing for reduction in edema as treatment progresses, and they must be at least 30-40 mmHg.
    o Each company has a formulary and specific brands of products that they provide, so be prepared for possible substitution of the brand that you may use in your practice. It is important to be flexible on this point.

  While there may seem to be lot of rules to remember and to be followed, it is really an easy program to work within and provide benefit to our patients.

  Dot is a registered nurse, received her wound certifications from the WOCNCB (CWON) and the AAWM (CWS), and has been practicing wound care since 1980. She is the Clinical Coordinator for Wound Care for Osceola Regional Medical Center in Kissimmee, Florida. Dot was a founding member and has held the office of Treasurer and President of the Association for the Advancement of Wound Care (AAWC), and is also a member of the Wound Healing Society (WHS), the Wound, Ostomy and Continence Nurses Society (WOCN) and the Florida Association of Enterostomal Therapists (FAET). She is the Co-Chair of the Symposium on Advanced Wound Care, is co-editor of the journal Today’s Wound Clinic, is on the faculty of the Wound Certification Prep Course, is a consultant and speaker for several manufacturers, and is a frequent speaker on all aspects of wound healing.