Hydrocolloid dressings are considered medically necessary for use on wounds with mild to moderate exudate. Up to 3 dressing changes per week are considered medically necessary for hydrocolloid wound covers or hydrocolloid fillers, unless it is documented that more frequent changes are medically necessary. This study included burn patients who underwent removal of 2 donor sites. Patients were followed at predetermined times for 30 to 45 days to determine reepithelialization time, aesthetic appearance and pain. The subjects were adult burn patients with less than 30% total body surface area burns (TBSA) who were admitted to the burn center and required excision and transplantation. A total of 20 patients were enrolled, 17 of whom completed the study. The median age was 35 years; The average combustion size was 9.2% TBSA. Patients underwent a harvest of split thickness skin grafts, with 1 donor wound covered with OxyBand and the other with xeroform gauze. The wounds were inspected and photographed on days 4 and 8 postoperatively, and then every 2 days until the donor wounds healed. During these visits, pain scores were also collected at each site (rated by patients on a scale of 0 to 10). The median time to wound healing for the OxyBand was 9.3 ± 1.7 days; for Xeroform: 12.4 ± 2.7 days (p < 0.001). Pain scores were lower at the OxyBand site at all time points 4 to 12 (p < 0.01) compared to the xeroform site. There was no difference in the aesthetic outcome of wounds 30 to 45 days after surgery.
The authors concluded that the results of this study showed a reduction in healing time and pain at donor sites dressed in an oxygen diffusion bandage. This was a small study (n = 17 subjects who completed the study); These preliminary results need to be validated by well-designed studies. The entire surgical dressing consists of a single layer of flesh-colored dermal tape placed on a solution adhering to mastisol™, which is applied to the skin edges of the incision (Figure 11-27). Drains are completely useless and undesirable in primary augmentation.1-4 Other additives such as special bras or straps, indwelling catheters for injecting local anesthetics, pain pumps, narcotic analgesics and implant movement exercises are also completely useless and undesirable as they unnecessarily complicate and prolong the patient`s recovery. Details of postoperative management according to the principles of 24-hour recovery are given in Chapters 20 and 21. Patients are advised to shower 3-4 hours after returning home, perform exercises to lift their right arms and leave the house for dinner, or shop on the night of surgery with ibuprofen as the only painkiller. With this regimen, 96% of the 627 patients returned to normal (non-aerobic) activities within 24 hours of augmentation.1,2 Contact layer dressings are used to line the entire wound to prevent adhesion of the overlying dressing to the wound. They are not useful and necessary when used with a dressing that has a non-adhesive or semi-adhesive layer in the dressing. They are not meant to be changed every time the dressing is changed. The dressing is changed up to once a week. Note: Wound debridement can be any type of debridement, including surgical (e.g., sharp instrument or laser), mechanical (e.g., wet to dry rinsing or dressings), chemical (e.g., topical application of enzymes), or autolytic (e.g., application of occlusive dressings to an open wound).
Medically necessary dressings used for mechanical debridement, to cover chemical debridement, or to cover wounds for autolytic debridement are covered by both HMO and traditional regimens as part of surgical dressing provision, although the chemical debrid agents themselves, when self-administered, are covered by pharmaceutical benefits. Lairet and colleagues (2014) found that speeding up the healing process and reducing pain during healing are beneficial for the following reasons: faster return to work, lower risk of wound infection, improved quality of life (QOL), and possibly reduced need for analgesia. In a prospective RCT, these researchers investigated the effectiveness of a new oxygen diffusion dressing (OxyBand; Oxyband Technologies, St. Louis, MO) versus standard xeroform gauze dressings (Convidien, Mansfield, MA) in the treatment of skin graft donor sites in burn patients. Healing time was the primary endpoint, and pain scores and aesthetic outcomes were also assessed. MACs are Medicare contractors who develop LCD screens and process Medicare claims. MACs develop an LCD screen when there is no national coverage (NCD) (for example, if an item or service is new) or if a DTM needs to be defined more precisely for the specific jurisdiction. LCD screens are specific to an item or service (procedure) and define the specific diagnosis (illness or injury) for which the item or service is covered. LCD screens describe how the contractor reviews claims to ensure that the services provided meet health insurance coverage requirements.
Before an LCD screen becomes final, the MAC publishes the proposed LCD screens, which include a public comment period. LCD document IDs begin with the letter “L” (for example, L12345). Suggested LCD document IDs begin with the letters “DL” (for example, DL12345). For guidelines for developing LCD displays, see Chapter 13 of the Medicare Program Integrity Handbook.
