ED Coding and Reimbursement Alert

Question: The nurses in our department are giving out wound care supplies to take home and use (one pack of 200 gauze sponges, 100 cotton-tipped applicators, one can solosite spray, and sterile saline solution). How do I code this? Is there a HCPCS code for wound-care supplies? Could I use A4649 (miscellaneous surgery supplies)?

Elissa Faustina
Corvallis, Ore.

Answer: When a physician, nurse practitioner, etc., applies dressings as part of a professional service that is billed to Medicare, the dressings always are considered incident to the professional service and are not separately payable.

But when surgical dressings are obtained by the patient for use at home from a supplier (drugstore, physician or other healthcare practitioner who qualifies as a supplier) on an order from a physician or other healthcare practitioner authorized by state law to make such an order, the surgical dressings are payable separately under Medicare Part B.

Coverage is limited to primary and secondary dressings required for the treatment of a wound caused by, or treated by, a surgical procedure that has been performed. Surgical dressings required after debridement also are covered, regardless of the type of debridement, as long as the debridement was reasonable and necessary and was performed by a healthcare professional acting within the scope of his or her legal authority.

Surgical dressings are covered for as long as they are medically necessary. There is no HCPCS code for a supply kit. The appropriate individual HCPCS codes in the A6xxx range should be used.