Today’s Wound Clinic 2019 Year in Review

This annual retrospective takes a look back at the best of TWC in 2019 and counts down the top 10 most read articles from the year.

As Today’s Wound Clinic started its 13th year in 2019, the January issue focused on regulation and compliance concerns. Dick Clarke, CHT, discussed the increasing pressures clinicians feel regarding government regulations for hyperbaric oxygen therapy (HBOT) in the wound clinic. The author discussed prior authorization and pre-payment review for HBOT.

Karen Eilert, RN, CWS, MSN, ACHRN, focused on revenue cycle management to avoid reimbursement denials for cellular- and tissue-based products (CTPs). She touched on having a thorough knowledge of codes and the importance of documentation to avoid leaving money on the table. To regulate safety in the wound clinic, Let’s Be Frank columnist Frank Aviles Jr., PT, CWS, FACCWS, CLT, emphasized the importance of reporting safety incidents. When treating patients who do not use animal products due to religion or ethical concerns, Jayesh B. Shah, MD, MSc, UHM (ABPM), CWSP, FAPWCA, FCCWS, FACHM FUHM, FACP, highlighted the need for respecting those backgrounds while administering wound products that are derived from animals.

In a January TWC podcast, Matthew Myntti, PhD, and Patricia Stevenson, MSN, ACNS-BC, CWS, discussed “The Emerging Science of Biofilm.”

February’s focus was wound care for the older patient. How can the wound clinic and skilled nursing effectively plan and coordinate care? Pamela Scarborough PT, DPT, MS, CWS, CEEAA & Dot Weir, RN, CWON, CWS, offered suggestions for solving issues that affect the continuity of care. Noting the importance of nutrition in the older patient, Nancy Munoz, DCN, MHA, RDN, FAND, discussed how nutrition can affect wounds, skin and pressure injuries.

Continuing his “Wound Care Around the World” series, Rafael Mazuz, MBA, explored wound care in Malaysia, detailing a recent visit to the Asian nation. As part of a video series, Daniel Kapp, MD, answered questions regarding debridement, such as the importance of debridement, what patients should expect after aggressive debridement, and how the clinician knows the debridement was effective.  

The March issue brought a farewell from Managing Editor Joe Darrah, who said goodbye to readers after seven years at TWC. In the same issue, as part of a focus on wound care and emergency medicine, Darrah wrote about the collaborative potential between chronic wound care and community paramedicine, interviewing Caroline E. Fife, MD, FAAFP, CWS, FUHM, on her experiences in this arena. In her editorial, Dr. Fife discussed the Sisyphean ordeal of re-hospitalizing patients, particularly those with chronic heart failure. Emily Greenstein, APRN, CNP, FACCWS, CWON, focused on the Sanford Care Wound Center and its community paramedic program. Kathleen D. Schaum, MS, offered a coding compliance self-test in her Business Briefs column.

I welcomed readers as I assumed the position of managing editor of TWC in April, an issue that focused on digital health. Mr. Mazuz drew upon his experience to offer suggestions for four ways wound clinics can integrate digital health. In Business Briefs, Ms. Schaum also discussed telehealth, including telehealth requirements, who can provide telehealth services, and what services are payable under the Medicare Physician Fee Schedule. Dr. Fife opined on how physicians can avoid common “wound care 101” pitfalls.

Skin care in the outpatient clinic was the focus of the May issue. Diane Dudas Sheehan, ND, APRN, FNP-BC; and Kathryn Chapman, MSN, APRN, CPNP-BC, CWON, offered a guide to treating skin and wounds in patients with muscular dystrophy. The authors focused on how muscular dystrophy affects skin integrity, also touching on pressure injuries. The issue also included a skin care patient handout and a look at innovative skin products.

Elsewhere in the May issue, Alan Block, DPM, discussed how collaborative care in the wound clinic can be beneficial for early presentations of Charcot foot. Dr. Fife pondered the implications of Medicare for All.

The wound care formulary was the subject of several articles in the June issue of TWC. David Schwegman, MD, FACEP, CWS; and Helen B. Gelly, MD, FACCWS, UHM/ABPM, FUHM, offered a practical guide to establishing a wound care formulary in the clinic, focusing on inventory, cost and formulary maintenance. To streamline a local wound care formulary, Elaine H. Song, MD, PhD, MBA; Catherine T. Milne, APRN, MSN, CWOCN-AP; Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA; Kathryn Whiston-Lemm, ACNP, CWCN, COCN-AP; Tiffany Hamm, BSN, RN, ACHRN, CWS; and Jeff Mize, RRT, CHT, CWC, offered several steps in an article and related video. Dr. Fife wrote about the infrastructure that girds wound formularies.

In Let’s Be Frank, Mr. Aviles provided a thoughtful discussion on choosing the right dressing for the right phase of wound healing. TWC also featured a guide to different types of advanced wound dressings.  

Several authors tackled the important subject of nutrition and wounds in the July issue. In a focus on diabetic foot ulcers (DFUs) and nutrition, Nancy Collins, PhD, RDN, LD, NWCC, FAND, discussed keeping blood glucose levels under control, nutritional screenings, and providing chairside advice to patients with diabetes on what foods to eat and what foods to avoid. Mr. Aviles looked at the evidence on how nutrition can reduce pressure ulcers, and emphasized a focus on outcomes. Dr. Fife noted that a value-based healthcare system may encourage wound care practitioners to focus on nutritional assessment, noting the impact of the new Quality Payment Program (QPP). Dr. Fife also recalled her encounter with nutrition pioneer Stanley Dudrick, MD. The July issue also featured a patient handout on diabetes and nutrition, as well as an online exclusive panel discussion on the diabetes, nutrition and wounds, which included Mr. Aviles, Nancy Munoz, DCN, MHA, RDN, FAND, and Kristen Smith, MS, RD, LD.

Elsewhere in the July issue, Ms. Schaum focused on negative pressure wound therapy (NPWT) in provider-based departments (PBDs) in her Consultation Corner column. In Business Briefs, Ms. Schaum and Donna Cartwright, MPA, RHIA, CCS RAC, FAHIMA, shared the revenue cycle management steps in which PBD staff should actively participate to positively influence the submission of accurate claims, which the authors note influences the PBD’s bottom line.

What is the current state of physician payments? The August issue attempted to answer this question. Given that the differences in coding between ulcers and wounds can be intricate, Ms. Cartwright offered a guide to how to use the correct codes for various ulcers or wounds, ensuring adequate payment. Ms. Schaum explored how physicians and qualified healthcare providers can expand their opportunities, focusing on home health care for chronic ulcers, consultation and virtual sharing of information. Dr. Shah wrote about telemedicine in wound care, discussing terminology, advantages and disadvantages, the position of the Centers for Medicare and Medicaid Services (CMS), and legal issues. Dr. Fife heralded the advent of Wound Compare.

HBOT and NPWT, both common treatments in wound clinics, were the subjects of numerous experts in the September issue of TWC. Helen B. Gelly, MD, FACCWS, UHM/ABPM, FUHM, discussed the prior authorization model for non-emergent HBOT, focusing on key points from the CMS final Evaluation of the Prior Authorization Model for Non-emergent Hyperbaric Oxygen. Presenting bad habits that cause the denial of payment for HBOT, Ms. Schaum detailed avoiding billing CMS for HBOT that was not ordered, providing HBOT for non-covered diagnoses, reporting incorrect supervision units, and submitting claims without adequate documentation. Nutritional optimization of patients for HBOT was the subject of an article by Tiffany Hamm, BSN, RN, ACHRN, CWS; Jeff Mize, RRT, CHT, CWCA; Elaine Horibe Song, MD, PhD, MBA; and Eugene R. Worth, MD, M.Ed., FABA, ABPM/UHM.

NPWT technology continues to evolve and this was explored in a September article by Stephanie Georgoudiou, MSN, APRN, AGPCNP-BC, CWCN; and Paul Kim, DPM, MS. The authors provided a case study as well as a look at the future of NPWT. Ms. Schaum answered some commonly asked questions on NPWT reimbursement, with a focus on durable medical equipment and disposable negative pressure devices. In a discussion of NPWT, Dr. Fife urged clinicians to think like oncologists, reporting the healing rates of the most difficult patients, rather than the easiest ones.

As wound clinicians attended the Symposium on Advanced Wound Care (SAWC) Fall in October, TWC was focused on reimbursement. Ms. Cartwright informed readers about the new 2020 ICD-10-CM codes for wound care, including phlebitis, thrombophlebitis, pressure ulcers, and personal history conditions. Ms. Schaum urged readers to prepare for the future, focusing on several coding updates coming in stages throughout 2020. Dr. Fife took a closer look at how a value-based payment system is replacing the old volume-based system. Also in the October issue, Diane G. Weiss, CPC, CPB, CCP, CHRI, suggested strategies to avoid audits, and Windy Cole, DPM; Stacey Coe, BA, CCRP, offered their expertise on how non-invasive pulsed acoustic cellular expression (PACE) can increase microcirculation and oxygenated hemoglobin for better healing of chronic wounds.

In November, several authors explored how Medicare is changing wound care. Dr. Fife explored Medicare’s Quality Payment Program (QPP), and how reporting quality measures can help improve care and outcomes for patients. Warning of the dangers of the “wounds with no name,” Dr. Fife also noted a new Local Coverage Determination (LCD) for debridement does not include DFUs among the conditions for which debridement is covered. Ms. Cartwright updated readers on the new ICD-11-MMS updates for 2020, including new chapters on Disorders of the Immune System, Diseases of Blood and Blood Forming Organs, Conditions Related to Sexual Health, Sleep-Wake Disorders, Traditional Medicine, and Extension Codes.

Following a successful year for the Wound Clinic Business (WCB) seminars, Ms. Schaum offered some reimbursement pearls and what they mean for wound and ulcer management. She also presented a video previewing what to expect from WCB 2020.

The December issue, available now, focuses on innovations in the wound clinic that can make for more accurate diagnoses. A panel discussion between Dr. Fife and Marcus Gitterle, MD, looks at innovative devices to assess the vascular status of patients, also delving into the advantages and disadvantages of established vascular testing methods. Barbara Aung, DPM, writes about the potential of fluorescence imaging in predicting wound closure and saving costs. Also in December, Mr. Mazuz provides a guide to managing your wound clinic’s finances, and Dr. Gelly notes the importance of your Hierarchical Condition Category Score. Meanwhile, in Let’s Be Frank, Mr. Aviles previews an exciting 2020 TWC educational wound care platform “that will allow clinicians to submit examples of difficult or interesting patient cases for others to provide their opinions, share similar experiences, and use their skills/expertise to help others who may have similar cases.”

Top 10 Most Read TWC Articles From 2019

10. A Closer Look at the New ICD-10-CM Codes for Wound Management in 2020
Donna J. Cartwright, MPA, RHIA, CCS, RAC, FAHIMA

9. Wound Dressing Selection Is More Than a Choice
Frank Aviles Jr., PT, CWS, FACCWS, CLT

8. Managing the ‘Weepy Leg’ of Chronic Wound Edema
Frank Aviles Jr., PT, CWS, FACCWS, CLT

7. Novel Bacterial Auto-fluorescence Imaging Device Can Lead to More Targeted Debridement
Windy Cole, DPM; and Stacey Coe, BA, CCRP

6. Hyperbaric Medicine: Feeling Pressure in the Wound Clinic
Dick Clarke, CHT

5. Diabetic Foot Ulcers and Nutrition: Making the Connection
Nancy Collins, PhD, RDN, LD, NWCC, FAND

4. Wound vs. Ulcer: Selecting the Correct Diagnosis Code
Donna Cartwright, MPA, RHIA, CCS RAC, FAHIMA

3. Nutritional Factors for Wound Healing in the Older Adult Patient
Nancy Munoz, DCN, MHA, RDN, FAND

2. Effective Care Planning Between the Wound Clinic & Skilled Nursing
Pamela Scarborough PT, DPT, MS, CWS, CEEAA & Dot Weir, RN, CWON, CWS

1. ICD-10 Coding for Soft Tissue Radiation Necrosis Treated with HBOT
Valerie J. Short, RN, ACHRN, CWCN, CWS, CMBS, FACCWS