Ohio Admin. Code 5160-10-34 - DMEPOS: wound dressings and related supplies
(A) Coverage.
(1)(2) Payment may be made
for wound dressings and related supplies as long as medical necessity
exists.
(2)(3) Payment may be made
for dressings placed over a percutaneous catheter or tube as long as the
catheter or tube remains in place and after removal until the insertion point
heals.
(3)(4) Clinical
indications, contraindications, and application guidelines for certain types of
wound dressing are summarized in the appendix to this rule.
(1)
No particular
form or format is specified for the certification of medical
necessity.
(B) Documentation.
(1) A prescription for a wound dressing or
related supply must
is necessarily be
based on an evaluation of the wound performed by a qualified
health care
healthcare provider. Frequent evaluation is expected
if a wound is heavily draining or infected. The
evaluation report must include wound type; wound location; wound length, width,
and depth; the amount of drainage; and any other relevant clinical information.
Any such report must
Each evaluation report,
which will be made available to the department on request,
includes the wound type; wound location; wound length, width, and depth; the
amount of drainage; and any other relevant clinical
information.
(2) The provider
must keep
keeps the prescription for dressings or related
supplies on file. The prescription must
include
includes the following clinical
information, which must not be more
can be no older than one year
old:
(a)
The type and number of wounds;
(b)
The type, size, and quantity of each dressing;
(c) The purpose of each dressing (e.g.,
primary or secondary covering for a surgical or debrided wound, wound
cleansing);
(d) The quantity to be
applied at one time (if more than one unit);
(e) The frequency of dressing change;
and
(f) The expected duration of
need.
(3) A prescription
is valid for not longer than three months. A new prescription is
required
needed for the addition of a dressing or for an
increase in the quantity of a dressing already prescribed. (No new prescription
is needed for a decrease in quantity.)
(C)
Requirements,
constraints,
Constraints and
limitations.
(1) Providers should not dispense
dressings that will be used together but have conflicting characteristics
(e.g., a hydrating dressing with an absorptive dressing, a primary dressing
that must be changed daily with a secondary dressing that needs to be changed
less frequently).
(2) The use of
more than one type of wound filler or more than one type of wound cover on a
single wound is rarely medically necessary. (An additional, dry wound cover is
not incompatible, however, with an alginate or other fiber-gelling dressing or
saline-, water-, or hydrogel-impregnated gauze.)
(3) Providers must
should gauge the
quantity of dressings actually being used by an individual and adjust the
dispensing of dressings accordingly. Not more than one month's supply of
dressings may be dispensed at one time.
(4) No payment is made for gauze impregnated
with water or normal saline, because there is no medical necessity for it.
Standard gauze may instead be moistened with bulk saline or sterile water.
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 01/07/2010, 07/16/2018
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