Check out new MC wound care coverage policy from CAHABA intermediary:
Evidence of Reasonable and Necessary Wound Care:
Medicare coverage for wound care on a continuing basis for a given wound in a given patient is contingent upon evidence documented in the patient's record that the wound is improving in response to the wound care being provided. It is neither reasonable nor medically necessary to continue a given type of wound care if evidence of wound improvement cannot be shown. Evidence of improvement includes measurable decreases in the following: drainage, inflammation, swelling, pain and wound dimensions (diameter, depth) or increased granulation tissue. Such evidence must be documented at least weekly. Generally a wound that shows no improvement after 3 weeks of a given type of wound care requires a new approach, including a physician reassessment of underlying metabolic, nutritional, or vascular problems inhibiting wound healing...
Reasons for Denial
1. Examples of situations in which visits are non-covered for wound care:
a. A Stage I pressure ulcer
b. A first degree burn
c. Wounds caused by trauma which do not require debridement, or surgical closure (e.g., minor skin tear or abrasion)
d. A venipuncture or arterial puncture site (e.g., blood sample) other than the site of an indwelling catheter or needle
2. Therapists performing wound care will not be covered:
a. If wound care does not fall within the auspice of the state practice act for the therapists, the services may be denied. (see other comments)
b. When the wound care is performed by a therapy assistant.
Expect that in the future, if you have a non-healting wound and if you don't try something differrent after three weeks, MC will stop paying for wound care. You just can't keep doing wet-dry drsg daily for 6 months without SOMETHING different tried.