APWCA

At its upcoming national meeting, March 25 to 27 in Philadelphia, PA, members of the American Professional Wound Care Association (APWCA) and other interested parties will gather to discuss the recent allowance by the Centers for Medicare and Medicaid Services (CMS) for coverage of compression stockings for patients with a history of venous ulcers. Although acknowledging that this coverage is a step forward, the APWCA believes the decision misses the point by not including leg edema without a prior venous ulcer as a covered disease state as well. Besides ulceration, lower leg edema can lead to tortuous varicosities, phlebitis, deep vein thrombosis, embolism, and infection, among others.

According to a report on the Web site of the Wound Ostomy & Continence Nurses Society, CMS does not view compression stockings as meeting the criteria for durable medical equipment or prosthetics. CMS says compressions stockings are not "reusable" as the "term was intended," nor are they a replacement for a dysfunctional organ or limb as prosthetics were intended to be. The CMS further suggests that Congress would needs to make legislative changes to broaden coverage.

APWCA contends that lower leg edema is a disease state, similar to the hemiparesis that occurs following a cerebrovascular accident. Compression stockings affect a different organ system and a different primary etiology. In addition, the APWCA questions how the term reusable differs when applied to compression stockings than when applied to a posterior splint.

APWCA does not believe this is a coverage issue, as CMS had already determined it would cover compression stockings for patients who meet the criteria. On the surface, then, it appears to be an issue of expanding the scope of coverage to include patients with leg edema from venous insufficiency or lymphedema, as well as those who had previously ulcerated.

Whether legislative change through Congress is required or whether CMS can be approached to readdress this ruling warrants further investigation and discussion, APWCA says, which is the point of the meeting scheduled for later in March. For further information, contact APWCA at 215-364-4100; fax: 215-364-1146; e-mail: [email protected].