In my opinion, a wound which is undermined is not stable enough to receive a CTP. This should be debrided and packed with a surgical dressing until the undermining or tunneling has resolved.
The current policies in my opinion, do not also allow for CTP products to be folded over (double thickness). They are to be used to cover and secured to the wound bed.
Thus I believe the amount use to “stuff” into a wound cavity which is being undermined or a folded over to increase the amount used, would not be supported by the current or future LCD.
"Dr. Kesselman, what if there is undermining to the wound? For instance, if the wound is visually 5 cm² and you utilize approximately 15 cm² additional to the undermining areas, can you claim 20 cm² of wastage on a 40 cm² cellular tissue product?" - abassdpm
Medicare MACs have seen an exponential use of CTP and the costs associated with them has grown exponentially along with their use. One of the issues that the Medicare MACs have been looking at is wastage. And this is why there has been a joint task force by the MACs to issue a joint policy on CTP, which should be released very shortly.
The short answer to your question is there is no hard and fast rule of a specific numeric value which would be considred excessive waste embedded in the policies covering the application of CTP’s.
The question you must satisfactorily document is whether or not you made an effort to use a product which closely matches the wound size?For example, if you have a wound of 40 sq cms and you choose to order a product which is 44 sq cms, you would likely be fine with a wastage of 4 sq cms.
Conversely, if you have a wound which is 5 sq cms and you order a 44 sq cms, you had better document why you chose a product which is 44 sq cms in size. Does it come in a smaller size? If so then that’s what you really should have ordered. Another consideration is if there is another suitable product with the same indications which is availalbe in a smaller size, why was that not used?
Of course documenting a specific “safe” margin to secure the CTP to the anatomical site must also be figured into the equation.
In summary, the Medicare carriers are looking for you to cut costs on wastage. That means ordering smaller size products and minimizing wastage.In some cases a smaller size of one product may actually cost more than a large size (with wastage) of another.Defending the margin of wastage and specifically which product you use in a specific situation will now be part of the required documentation.
We are being told that we need to reduce or “minimize” our wastage when applying Cellular Tissue Products. Is there a hard and fast formula which CMS or other carriers follow to determine an exact value of what that means? - WoodsideDR
Great follow up question.
In my opinion, a wound which is undermined is not stable enough to receive a CTP. This should be debrided and packed with a surgical dressing until the undermining or tunneling has resolved.
The current policies in my opinion, do not also allow for CTP products to be folded over (double thickness). They are to be used to cover and secured to the wound bed.
Thus I believe the amount use to “stuff” into a wound cavity which is being undermined or a folded over to increase the amount used, would not be supported by the current or future LCD.
I look forward to the opinions of others.
"Dr. Kesselman, what if there is undermining to the wound? For instance, if the wound is visually 5 cm² and you utilize approximately 15 cm² additional to the undermining areas, can you claim 20 cm² of wastage on a 40 cm² cellular tissue product?" - abassdpm
Medicare MACs have seen an exponential use of CTP and the costs associated with them has grown exponentially along with their use. One of the issues that the Medicare MACs have been looking at is wastage. And this is why there has been a joint task force by the MACs to issue a joint policy on CTP, which should be released very shortly.
The short answer to your question is there is no hard and fast rule of a specific numeric value which would be considred excessive waste embedded in the policies covering the application of CTP’s.
The question you must satisfactorily document is whether or not you made an effort to use a product which closely matches the wound size?For example, if you have a wound of 40 sq cms and you choose to order a product which is 44 sq cms, you would likely be fine with a wastage of 4 sq cms.
Conversely, if you have a wound which is 5 sq cms and you order a 44 sq cms, you had better document why you chose a product which is 44 sq cms in size. Does it come in a smaller size? If so then that’s what you really should have ordered. Another consideration is if there is another suitable product with the same indications which is availalbe in a smaller size, why was that not used?
Of course documenting a specific “safe” margin to secure the CTP to the anatomical site must also be figured into the equation.
In summary, the Medicare carriers are looking for you to cut costs on wastage. That means ordering smaller size products and minimizing wastage.In some cases a smaller size of one product may actually cost more than a large size (with wastage) of another.Defending the margin of wastage and specifically which product you use in a specific situation will now be part of the required documentation.
We are being told that we need to reduce or “minimize” our wastage when applying Cellular Tissue Products. Is there a hard and fast formula which CMS or other carriers follow to determine an exact value of what that means? - WoodsideDR