Complicated Wound Examples
Medicare
Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.1.2.8)
CMS states if appropriate active treatment has been ordered (e.g., sterile or complex dressing, administration of prescription medications), the skills of a nurse are usually reasonable and necessary for wounds with the following characteristics:
- Open wounds draining purulent or colored exudate, which have a foul odor present, or for which antibiotics are being administered
- Wounds with a drain or T-tube that require shortening or movement
- Wounds requiring irrigation or installation of sterile cleansing or medicated solution into several layers of tissue and/or packing with sterile gauze
- Recently debrided ulcers
- Pressure sores (decubitus ulcers) that present one of the following characteristics:
- Partial tissue loss with signs of infection such as foul odor or purulent drainage
- Full thickness tissue loss that involves exposure of fat or invasion of other tissues such as muscle or bone
- Wounds with exposed internal vessels or a mass that may have a tendency for hemorrhage when a dressing is changed (e.g., post radical neck surgery, cancer of the vulva)
- Open wounds where there is an underlying disease that has a reasonable potential to adversely affect healing (e.g., diabetes)
- Third degree burns and second degree burns where the size of the burn or presence of complications causes skilled nursing care to be needed
Wounds or ulcers that show redness, edema, and induration, at times with epidermal blistering or desquamation, do not ordinarily require direct hands-on skilled nursing care. Although a wound might not require hands-on care, it may still require skilled observation for signs of infection or complications or skilled teaching of wound care.
Updated: 07.30.12
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