Compression Stockings Documentation Needs
The following qualification criteria need to be documented in the patients’ medical record notes to qualify for the prescribed equipment.Â 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 patients 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 NGSMedicare.com for any additional qualifying information questions, diagnosis codes and descriptions
Medicare approved detailed equipment descriptions for compression stockings
Compression stockings, Gradient 30 -40 MMHGÂ - 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 MMHGÂ - 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 letter head 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.