Ohio Admin. Code 5160-10-34 - DMEPOS: wound dressings and related supplies
(A)
Coverage.
(1)
Payment may be
made for wound dressings and related supplies as long as medical necessity
exists.
(2)
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)
Clinical
indications, contraindications, and application guidelines for certain types of
wound dressing are summarized in the appendix to this rule.
(B)
Documentation.
(1)
A prescription for a wound dressing or related supply
must necessarily be based on an evaluation of the wound performed by a
qualified health care 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 be made available to
the department on request.
(2)
The provider must
keep the prescription for dressings or related supplies on file. The
prescription must include the following clinical information, which must not be
more 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 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, 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
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.
Replaces: 5160-10-34
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 01/07/2010
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