CORRECT CODING – SURGICAL DRESSINGS CONTAINING NON-COVERED COMPONENTS


DME MAC Joint Publication

RESCINDED (Effective 6/12/2015): This article has been rescinded and will be reposted when revised by the DME MACs

Some surgical dressings are produced containing non-covered components.  This article reviews the coding guidelines for these items.  The Surgical Dressings Local Coverage Determination (LCD) related Policy Article (PA) states:

“Products containing multiple materials are categorized according to the clinically predominant component (e.g., alginate, collagen, foam, gauze, hydrocolloid, hydrogel). Other multi-component wound dressings not containing these specified components may be classified as composite or specialty absorptive dressings if the definition of these categories has been met. Multi-component products may not be unbundled and billed as the separate components of the dressing."  (PA Coding Guidelines)

Historically, non-covered components have not been the majority constituent in multicomponent products.  Recently, dressings where the non-covered components comprise the majority of the dressing have been identified. 

The coding guideline for multi-component dressings states that the clinically predominant component will determine classification.  Following this guideline:

  • Dressings only containing non-covered components, with or without a substrate, are coded as A9270 (Non-covered item or service)
  • Multicomponent dressings are coded based upon the clinically predominant component. For dressings that contain non-covered elements:
    • If the non-covered components are less than 50% of the dressing, coding is determined by the predominant covered component.
    • If the non-covered components comprise 50% or more of the dressing, the dressing is assigned to code A9270 (non-covered item or service).
      Refer to the Surgical Dressing LCD and related PA for additional information about coding and coverage.
      For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com/

Published by Noridian as the PDAC, January 2015, Updated June 2015.  Republished by Palmetto GBA as the PDAC, February 2019.  Please note that links in this document were accurate at the time of original publication and may change over time and are no longer active.

 

Last Updated: 01/27/2015