Skip to main content
Corporate
CGS Administrators, LLC

Serving the states of MN, WI, IL, IN, OH, KY and MI

August 13, 2015

Surgical Dressings Containing Unclassified Materials - Correct Coding

DME MAC Joint Publication

Note: A previous version of this article was published in January 2015. The January publication was subsequently removed due to an inaccuracy in a reference to A9270. This article replaces that previous publication.

Some multi-component surgical dressings contain materials for which no specific HCPCS code exists. This article reviews the coding guidelines for these items.

Historically, materials not having specific HCPCS codes have not comprised the majority constituent(s) in multi-component products. Thus, these materials were not taken into consideration for HCPCS coding purposes. The longstanding coding guideline for multi-component dressings states that the clinically predominant component will determine classification. The current Surgical Dressings Local Coverage Determination (LCD) related Policy Article (PA) Coding Guidelines says:

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.

Recently, multi-component dressings with non-classified (non-coded) components comprising the majority of the dressing's materials have been identified. The following clarification to the current guideline is being published in order to assure consistent interpretation of the "clinically predominant component" criterion. The revised coding guidelines clarify how products with non-coded materials are to be classified:

Multi-component dressings that are not classified as composite dressings are categorized according to the clinically predominant component. The clinically predominant component is defined based on the proportion of material(s) in the dressing. For example, a dressing that is 60 percent hydrocolloid and 40 percent alginates would be categorized as a hydrocolloid dressing. HCPCS coding is determined based on the following:

The Surgical Dressings LCD related Policy Article Coding Guideline section will be updated to include this information.

Refer to the Surgical Dressing LCDExternal Website and related Policy ArticleExternal Website for additional information about coding and coverage.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (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/External Website

Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved