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Dermagraft

P

PLAIDMAN

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I am wondering if anyone is aware of any rules stating that you can NOT split a Dermagraft?

My doc typically does not need the whole graft for one patient, so he wants to split the graft in half and use it on two patients in the office back to back.

Of course I would only bill half the units for each patient, but, I spoke to the Dermagraft rep (yuck) and he told me not to do this, however, he could give me no reason or site any payor rules stating that you could not do it?????

Why would a payor would want to pay for waste when we can split the cost????

Any thoughts would be helpful.
Thanks
 
See link & the pasted info from Trailblazer Health LCD on Dermagraft:

http://www.trailblazerhealth.com/Tools/LCDs.aspx?DomainID=1


Product Wastage

Medicare provides payment for the amount of the bioengineered skin substitute product that is reasonable and necessary to treat the patient's wound. If the physician has made good faith efforts to minimize the unused portion of the bioengineered skin substitute product in how patients are scheduled and how he ordered, accepted, stored and used the product and made good faith efforts to minimize the unused portion of the product in how it is supplied, the program will cover the amount of product discarded along with the amount used to treat the wound. Documentation requirements for unused/discarded materials are given below. Discarded materials must be reported separately from the medically necessary material used to treat a wound. Coding and billing instructions for discarded materials are referenced in the attached article. Coding and billing instructions can be referenced in the attached article. Refer to national policy: Medicare Claims Processing Manual – Pub. 100-04, Chapter 17, Section 40.

Medicare will monitor and evaluate claim data related to discarded materials. Seeking additional payment from Medicare (by reporting on a separate claim materials previously reported as discarded) for wasted/discarded material constitutes a false claim – a felony crime punishable under federal law.[/I][/I][/I]
 
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