The DME MACs have released a bulletin reminding suppliers of Negative Pressure Wound Therapy (NPWT) that there are stringent documentation requirements in the local coverage determination (LCD). Elements of the LCD that require information from the medical record to justify coverage include:

• Complete description of the wound
• Description of prior care for the wound
• Complications with surgically‐created wounds
• Monthly monitoring of wound healing progress
• Need for more than four months therapy
• Need for a quantity of supplies that exceeds the expected amounts outlined in the LCD

Suppliers should review the “Indications and Limitations of Coverage and/or Medical Necessity” section of the LCD for a complete discussion of coverage criteria.

As noted in the “Documentation Requirements” section, the following types of information may be requested in the event of a claim review:

Documentation of the history, previous treatment regimens (if applicable), and current wound management for which an NPWT pump is being billed must be present in the patient’s medical record and be available for review if requested by the DMERC. This documentation must include such elements as length of sessions of use, dressing types and frequency of change, and changes in wound conditions, including precise measurements, quantity of exudates, presence of granulation and necrotic tissue and concurrent measures being addressed relevant to wound therapy (debridement, nutritional concerns, support surfaces in use, positioning, incontinence control, etc.). Documentation of wound evaluation and treatment, recorded in the patient’s medical record, must indicate regular evaluation and treatment of the patient’s wounds, as detailed in the Indications and Limitations of Coverage Section. Documentation of quantitative measurements of wound characteristics including wound length and width (surface area), and depth, and amount of wound exudate (drainage), indicating progress of healing must be entered at least monthly. The supplier of the NPWT equipment and supplies must obtain from the treating clinician, an assessment of wound healing progress, based upon the wound measurement as documented in the patient’s medical record, in order to determine whether the equipment and supplies continue to qualify for Medicare coverage. (The supplier need not view the medical records in order to bill for continued use of NPWT. Whether the supplier ascertains that wound healing is occurring from month to month via verbal or written communication is left to the discretion of the supplier. However, the patient’s medical records may be requested by the DMERC in order to corroborate that wound healing is/was occurring as represented on the supplier’s claims for reimbursement.)

Suppliers should note the highlighted statement from the Documentation Section requiring frequent contact with the treating clinician to assess the continued need for therapy.

Suppliers should refer to the Supplier Manual, LCD and Policy Article for additional information on NPWT and other general documentation requirements.