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| Surgical Dressings A6209 - A6214 – Notification of Prepayment Review The National Government Services, Jurisdiction B Medical Review department will be initiating a prepayment widespread service review for surgical dressings A6209-A6214. A widespread service review is a 100% prepay review of submitted claims with the above mentioned codes from multiple suppliers for medical necessity. The findings from the initial widespread probe review showed that a large number of suppliers are submitting claims for surgical foam dressings when the wound does not qualify for this type of dressing and/or frequency of dressing changes. Suppliers of the selected claims will be sent a documentation request letter in the mail for the information listed below. The requested documentation must be returned by 30 days from the date of the letter or the claim will be denied as not medically necessary. Suppliers are reminded when submitting documentation in response to an Additional Documentation Request (ADR) letter to please include the copy of the ADR letter with the documentation that is being requested. Returned documentation should include the following per Surgical Dressing LCD #27222: 1. Signed and dated detailed written physician s order that includes (a) the type of dressing, (b) the size of the dressing, (c) the number/amount to be used at one time, (d) the frequency of dressing change, and (e) the expected duration of need. 2. Documentation defining the number of wounds being treated with a dressing. 3. Documentation of evaluation of the wound(s) during the month prior to the date of service on the claim that includes the type of each wound (e.g., surgical wound, pressure ulcer, burn, etc), location, size (length x width in cm.) and depth, amount of drainage and/or any other relevant information. These records must be obtained from the physician, nursing home, homecare nurse or outpatient centers. The source of that information must be documented. 4. Proof of delivery to verify that the beneficiary received the dressings. |
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