Home care agencies are aware that proper wound documentation on the OASIS is imperative for appropriate Medicare Part A payment. Many nurses are surprised to learn that proper documentation also affects Medicare Part B reimbursement of dressings after the patient/ caregiver has learned the wound procedure and is discharged.

The Medicare Part B Surgical Dressing Policy specifies the coverage criteria for dressings after the wound care patients are discharged from the home care agency. The order for surgical dressings must specify the type of dressing, size of dressing, number/amount to be used at one time, frequency of dressing change, and expected duration of need.

The supplier's records should document information obtained from the physician, nursing home, home care agency, etc. For example:

* the number of surgical/ debrided wounds to be treated with the dressing

* the reason for the dressing use, and

* whether the dressing is used as a primary or secondary dressing.

The evaluation of the patient's wound must be documented in the home care agency's and physician's medical record: Type of wound, location of wound, size (length x width in cm) and depth of wound, and amount of wound exudate.

The documented amount of exudate is one of the main coverage guidelines for the Surgical Dressing Policy categories of dressings. Most of the absorptive dressing category guidelines specify the amount of exudate that must be present to qualify that dressing category as medically necessary (see Table 1).

Table 1. Surgical Dressing Policy Wound Exudate Guidelines

For example: If the medical record documentation states that the patient's wound has a minimal amount of exudate and the discharge order is written for a foam dressing, Medicare will most likely deny Medicare Part B payment for the foam dressing. The reason is because the Surgical Dressing Policy coverage guidelines for the foam dressing category states that foam dressings are for wounds with moderate to heavy exudate.

Therefore, home care agencies need to be cautious that their documentation appropriately justifies the type of dressings that are ordered for patients discharged from the agencies' services.