CORRECT CODING – HCPCS CODING OF SURGICAL DRESSINGS – COMPONENTS TO REPORT ON THE PDAC HCPCS CODE VERIFICATION APPLICATION
DME MAC Joint Publication
HCPCS coding of surgical dressing products requires reporting the amount (percent by weight) of each product's constituent components. However, every individual component is not required to be included in the composition analysis reported in the PDAC Code Verification Application. To assist manufacturers in submitting the most accurate information, this article will review the relevant coding guidelines.
The Surgical Dressings LCD related Policy Article Coding Guidelines section says, in relevant part:
Products containing multiple materials (excluding basic construction elements such as backing material, adhesive used in borders, binders, preservatives, etc. (not all-inclusive)) are classified as either composite dressings or as multi-component dressings. Impregnated gauze dressing are not included in this classification.
Composite dressings (A6203-A6205) are products combining physically distinct components into a single dressing that provides multiple functions. These functions must include all of the following:
- A physical (not chemical) bacterial barrier that is present over the entire dressing pad and extends out into the adhesive border,
- An absorptive layer other than an alginate or other fiber gelling dressing, foam, hydrocolloid, or hydrogel, and
- Either a semi-adherent or a non-adherent property over the wound site.
Surgical dressings with a backing that provides a physical bacterial barrier but does not have an adhesive border do not meet the definition of a composite dressing because there is no assurance that it will prevent bacterial access to a wound. These types of dressings are to be coded as specialty absorptive dressings (A6251-A6253).
Multi-component dressings that are not classified as composite dressings are categorized according to the clinically predominant component. The clinically predominant component is defined based on the proportion of material(s) in the dressing. For example, a dressing that is 60 percent hydrocolloid and 40 percent alginates would be categorized as a hydrocolloid dressing. HCPCS Coding is determined based on the following:
- Products where a single material comprises greater than 50% (by weight) of a product's composition are coded based upon the applicable specific HCPCS code for that material. If a specific HCPCS code does not exist for the predominant component, HCPCS code A4649 is used.
- Products where no single material comprises greater than 50% (by weight) of the composition are coded as A4649.
Composite and multi-component products may not be unbundled and billed as the separate components of the dressing.
Correct coding for dressings that contain multiple materials such as composite and multi-component dressings (not all-inclusive) is based upon the composition and combination of the clinically relevant materials. Basic construction elements such as backing material, adhesives used in borders (including full-surface adhesives), binders, preservatives, etc. are not necessary for the coding analysis. These basic construction materials do not need to be included in the compositional analysis reported as part of the PDAC HCPCS Code Verification Application. Manufacturers should only report those materials that contribute to the clinical function of the product. Inclusion of these basic construction materials as part of the composition analysis may result in a delay in coding and/or an incorrect HCPCS code assignment.
Manufacturers should note that these basic construction elements may need to be discussed elsewhere in the coding application. Some dressing types have requirements for adhesive borders, bacterial barriers, etc. Demonstrating compliance with these criteria often requires the inclusion of basic construction components.
Refer to the Surgical Dressings LCD, related Policy Article, and Standard Documentation Article for additional information regarding coverage coding and documentation for these items.
Suppliers are reminded to access the PDACs Durable Medical Equipment Coding System (DMECS) https://www4.palmettogba.com/pdac_dmecs/ for any questions regarding the correct coding of products or call the PDAC Contact Center at 877-735-1326 between the hours of 8:30 a.m. and 4:00 p.m. CT.
Published by Noridian as the PDAC, October 2017. Republished by Palmetto GBA as the PDAC, January 2019.