wound care

[ebarnett]

I need some help with wound care. My podiatrist wants to bill 15430 for application of Oasis collagen wound matrix and I want to be sure his documentation supports this. Here's the report:


The patient presents to _______ Wound Care Center for followup
evaluation of midfoot ulceration, which we have been treating over
the course of the past several months. The patient has sustained
direct trauma to this area secondary to noncompliance and
weightbearing following resection of the 4th and 5th metatarsals
for treatment of osteomyelitis and abscess formation.

Physical examination of the patient's lower extremity today
reveals no ulceration at the level of the midfoot with complete
resolution and healing at the surgical site. The previous area of
anterior ankle ulceration has remained completely resolved.
However, the patient now has a new ulcer at the plantar aspect of
the heel, which is with multiple punctate satellite areas along
the heel with depth of approximately 0.1 cm and diameter of
approximately 1 x 1 cm, in series of 4-5 different lesions. The
area appears to be erythematous secondary to irritation and
pressure being placed on the plantar and posterior aspects of the
heel. The patient has been donning her Posey boot; however, it
does appear as if some pressure has been borne on the lower
extremity in this area, which would be the cause for the recent
new breakdown. The patient's lower extremity epidermis is very
thin and fragile due to the past history of previous ulceration,
which also lends itself for further breakdown and wound
complication. The area appears to be without infection; however,
there is a great deal of sloughing skin noted at the heel, part of
which is partially adhered. There is some concern about localized
debridement potentially causing further excoriation and wounds.
Therefore, the patient will be referred for physical therapy and
whirlpool treatment for aquatic debridement.

DIAGNOSIS
1. Decubitus ulceration of the heel.
2. Resolution of midfoot ulceration.


Treatment today is:
1. Referral for whirlpool debridement x5.
2. Application of Oasis collagen wound matrix under sterile
conditions following wound bed preparation via debridement
with application of Adaptic, 4 x 4's, 4-inch roll bandage,
and 4-inch Ace bandage.
3. The patient is to remain completely nonweightbearing on the
affected lower extremity.
4. Patient will return to St. Mary's Wound Care Center in 1 week
for further evaluation.

[mkj2486]

Here are a couple of links I found in regards to coding the Oasis Wound Matrix, I hope this helps.

http://medicarebb.wpsic.com/med-foru...tml?1166026820

http://www.o-wm.com/files/docs/Healt..._September.pdf

[Cheri CPC]

15430 is the correct code for application of Oasis up to 100 sq cm. There is a few problems though with this documentation. The Oasis needs to be "affixed" , Oasis is usually affixed with steri-strips, however, here it looks like it is just stabilized with dressings. If it isn't affixed, it is considered a "wound dressing" and you would only be able to code the debridement,,, which has a problem too, as he doesn't state the depth, e.g. partial thickness, full thickness, subq,,,etc.
Also will probably be denied with a pressure ulcer code. Usually used on venous insufficient and diabetic ulcers.