My question is this: when a provider is considering the use a of biologic the LCD if available or the required parameters under the product use guidelines must be followed. Not every wound requires a biologic wound graft. I get that, but what I do not get is whether or not there is an actual standard of care, local or national, that a provider must adhere to when using these grafts? Or should they just use their better judgement, clinical experience, morality and medical integrity rather than how much they can profit from performed wound care using biologics?
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Let me start with your first part, standard of care. We know that means, the care rendered by the typical doctor in your community, will provide specific conservative care when it comes to wounds. Most include dressings, topical medications, antibiotics when necessary, offloading, tobacco use cessation, etc. There are numerous ways to treat wounds and surgery may be required from as a simple wound debridement, I&D, to bone surgery and that may involve amputation. As you can see the care varies, besides what was mentioned, providers can ultimately select the option for skin substitutes if they meet the current LCD mandates of minimum of 4 weeks for DFU and 3 months for VLU. Please note, most LCD's don't go beyond these 2 types of wounds which get restricted by the LCD's. For example, burns and decubitus pressure ulcers are not part of the LCD process and should not be considered with the LCD restrictions currently imposed on providers by the MACS. Most do not realize this fact including the government auditing bodies that include UPICS and SMRCs! Selecting the most appropriate care should be the best option for the patient, my thought is to suggest the skin substitute you have used that works best in your hands. Medicine is not an exact science. No one type of skin substitute works best on all wounds.