Medicare Carrier Removes Wound Debridement Restrictions

Family physicians in four states -- Texas, Delaware, Maryland and Virginia -- and the District of Columbia should be pleased with the positive outcome of the AAFP's efforts to remove restrictive language from a Medicare carrier's draft local coverage determination, or LCD, on wound care.

Last December, AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., questioned TrailBlazer Health Enterprises' proposed limitations on wound debridement. "Our concern with the given utilization guideline is the seemingly arbitrary limit of three times for coverage of debridement of a given wound," said Fields' letter, pointing out that language in the carrier's own LCD stated that although repetitive debridement of an individual wound is uncommon, sometimes, as with the medical condition osteomyelitis, serial debridement is the only option.

"In such cases, we believe that medical necessity should govern Medicare coverage," said Fields in the letter.

In early April, the AAFP learned that the offending language had been stricken from the "Utilization Guidelines" section of TrailBlazer's final policy (scroll to the bottom of the CPT licensing page and select "I accept" to gain access to the document).

"The Academy got the result it wanted," said Kent Moore, AAFP manager of health care financing and delivery systems. "The remaining coverage limitation on debridement is limited to just two CPT codes, both of which cover extensive debridements done by family physicians less than 5 percent of the time," he added.