Compression stockings documentation needs
The following qualification criteria need to be documented in the patients’ medical record notes to qualify for the prescribed equipment. Note: Justification notes are valid for six months.
All need to be appropriately documented to qualify. Note: Patient must have open venous stasis ulcer to qualify for payment from insurance companies.
- Describe in detail the patients open venous stasis ulcer.
- Describe the location of the open venous stasis ulcer.
- Describe the stage of the patient’s venous stasis ulcer:
|Suspected Deep Tissue Injury- Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.|
|Stage I- Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching: its color may differ from the surrounding area.|
|Stage II– Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.|
|Stage III- Full thickness tissue loss with exposed bone, tendon or muscle are not exposed. Slough may be present but not obscure the depth of tissue loss. May include undermining and tunneling.|
|Stage IV- Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.|
|Unstageable- Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, green or brown) and/or eschar (tan, brown or black) in the wound bed.|
Diagnosis: See LCD (Local coverage determination) at CGSMedicare.com for any additional qualifying information questions, diagnosis codes and descriptions
Medicare approved detailed equipment descriptions for compression stockings
|Compression stockings, Gradient 30 -40 MMHG – Knee/Thigh/Waist, Bilateral/Right/Left, (HCPC-A6531)|
|Compression stockings, Gradient 40-50MMHG – Knee/Thigh/Waist, Bilateral/Right/Left, (HCPC-A6532)|
|Compression wrap, Gradient, non-elastic, 30-50 MMHG – Knee/Thigh/Waist, Bilateral/Right/Left, (HCPC-A6545)|
Patient notes/justification – Must be documented using your normal dictation process. Letter of medical necessity, notes wrote on letterhead or prescriptions are not valid.
Prescription/order requirements– Must contain Patient’s name, date of the order and Start date, detailed equipment description (See above), signature of the ordering physician and a signature date.