[disney158]

HELP ! I have never been too conservative with Medicare Part A coverage, but I think this is definatley pushing the edge of what can be covered. Patient admitted with wound vac, the standard change vac every 3 days, of course it is checked each shift by a nurse, but the vac dressing is not taken down... would you cover this under Medicare Part A ? I'll admit, I am old and always fall back on what I had previously learned that the wound bed must be treated dailey. I do not feel that looking at a vac is treating the wound.. the facility I work part time at is very agressive in financail terms and a consultant is saying that nurses can chart on the functioning of the vac, the skin around the vac....etc, for dailey skilled coverage. Can anyone show me regulation's that this is okay or not okay ? I feel really uncomfortable here, and I know that the nurses notes are not too good either !!

[Rexie68]

It is my understanding that a stage III or higher pressure ulcer qualifies for Medicare A coverage, assuming the other regs are met (3 day hospital stay, pressure ulcer r/t admission dx in hospital, etc). If it's a surgical wound, that should also qualify as skilled. I could be wrong, but we skill for wounds under Medicare A even if the dressing is not changed daily. We have skilled for wound vacs with standard dressing change of every 3 days. As far as the nurses charting, I leave a list of things that need to be included in each skilled residents nurses note. That way the nurse can refer to it when charting. Still doesn't make perfect nurses notes, but they staff says it's helpful, and we've never had a problem with Medicare denying the claim. Hope this helps!!

[Talino]

I would not focus solely on the VAC therapy itself.

"Observation and assessment are skilled services when the likelihood of change in a patient’s condition requires skilled nursing or skilled rehabilitation personnel to identify and evaluate the patient’s need for possible modification of treatment or initiation of additional medical procedures, until the patient’s treatment regimen is essentially stabilized." Principles for Determining Whether a Service is Skilled pp 21-25

Was it necessary to assure proper body alignment in order to avoid contractures and deformities? Was special nutrition provided to facilitate the healing process? Is site checked daily for presence of bleeding or change in skin color? Was it necessary to adjust pain meds? When the site is evaluated on the 3rd day, will there be a need to modify the plan of care to promote recovery or ensure medical safety? If these interventions were not applied, would the resident's condition remain uncompromised? Blah blah blah. Knowing about VAC Therapy may assist you on what to watch for (documentation-wise) while the therapy is in place. http://www.kci1.com/Clinical_Guidelines_VAC.pdf

Good documentation is crucial.

[disney158]

Thanks to all, the facility documentation, frankly, stinks, which I another reason why I do not want to cover this. And no amount of education, cheat sheets, etc., has made this better, I have even asked if the unit manager herself could write a good dailey note to at east have an RN note ther rather than the usual , vital sings, ate well , vac on and functioning, that got nowhere, so , it will be considered Med. A as I am being told to do so. That vac is stuck on and not touched or looked at by anyone other than CNA's who bathe and groom the resdinet, unless it leaks or falls off, for 3 days. In my mind now, I voiced my opinion and when, if it comes up for review I will not be held responsible,

[edhcinc]

Hi-you may want to check out this DME billing reminder, issued in 5/07. It clearly indicates situations where Vac is coverable, and the documentation required. It is not a regulation, but an explanation of coverage criteria.

www.medicarenhic.com/dme/articles/052407_npwt.pdf

Keep in mind that wound vac supplies are included in the daily rate for Med A patients. This patient would normally fall into the Special Services RUG--somewhere around $250 to $280/day. Vac supplies as well as a specialty bed may "eat up" most, if not all, of this daily rate.

If the documentation does not support the provision of daily direct or indirect skilled services, Med A should be denied, and another payment source (private, MA, whatever...) should begin. The wound vac can then be billed to Medicare Part B. (most of the time the supplier does this billing)

Good luck!

[CapeCodMermaid]

Originally Posted by Talino

I would not focus solely on the VAC therapy itself.

"Observation and assessment are skilled services when the likelihood of change in a patient’s condition requires skilled nursing or skilled rehabilitation personnel to identify and evaluate the patient’s need for possible modification of treatment or initiation of additional medical procedures, until the patient’s treatment regimen is essentially stabilized." Principles for Determining Whether a Service is Skilled pp 21-25

Was it necessary to assure proper body alignment in order to avoid contractures and deformities? Was special nutrition provided to facilitate the healing process? Is site checked daily for presence of bleeding or change in skin color? Was it necessary to adjust pain meds? When the site is evaluated on the 3rd day, will there be a need to modify the plan of care to promote recovery or ensure medical safety? If these interventions were not applied, would the resident's condition remain uncompromised? Blah blah blah. Knowing about VAC Therapy may assist you on what to watch for (documentation-wise) while the therapy is in place. http://www.kci1.com/Clinical_Guidelines_VAC.pdf

Good documentation is crucial.

That material is put out by KCI the people who make one kind of wound vac...otherwise called negative pressure therapy. V.A.C. is a tradename of KCI.