2024 DMEPOS Series #4: Surgical Dressings

• Standard Written Order (SWO)
  • A new order is required every 3 months for each qualified dressing dispensed, or sooner if the quantity required increases
• Medical Records must support the surgical dressings are required for one of the following:
  • Treatment of a wound caused by, or treated by, a surgical procedure, or used after debridement of a wound
  • Initial wound evaluation must include:
    • Type, location, number, and size of qualifying wounds (L x W and depth)
    • Amount of drainage
    • Frequency of dressing change
  • Ongoing wound evaluation (weekly or monthly)
  • Specific dressing coverage criteria (in addition to meeting the criteria for qualifying wound)
  • Covered diagnoses can be found in the Local Coverage Determination (LCD) and Policy Article
• Proof of Delivery
• Proof of Refill Request and Affirmative Response
  • Required if delivered or mailed

PAAS Tips:

• Attach modifiers (A1-A9) to indicate the number of wounds on which the dressing is being applied
• If using A9, must also submit actual number of wounds being treated in narrative on electronic claim
• Download PAAS’ Proof of Refill Request and Affirmative Response form on the Member Portal where you can document the required information from the beneficiary or their caregiver
• Review documentation checklist for Jurisdiction A and D
• Review documentation checklist for Jurisdiction B and C
• Review Surgical Dressings Q&As from CGS®
• Review the following Newsline articles for additional information:
  • August 2023: Standard Written Order and Medicare Part B Audit Risks – New Guidance
  • February 2024: DMEPOS Updated Refill Request and Affirmative Response Requirements