Draft LCD could complicate wound care

Thursday, September 29, 2011

BALTIMORE – Suction pumps and negative pressure wound therapy devices (NPWT) need consistent coverage criteria to ensure patient care, AAHomecare told the four medical directors in a Sept. 23 letter.

In August, the DME MACs released draft local coverage determinations (LCDs) that would create separate coverage criteria for pumps. They would add a not reasonable and necessary statement for wound suction pumps (K0473) and related supplies (K0744—K0746); and add new coverage criteria for gastric suction pumps.

Such a move would effectively create a separate category for suction pumps. That, in turn, would make it difficult for physicians to order the best device, and for HME providers to determine which product might work best.

"We want to make it consistent for physicians, for patients and for providers so that the patient can have the continuum of care with the full range of products," said Alex Bennewith, senior manager of government affairs for AAHomecare.

Without that consistency, a patient would meet the coverage criteria for one device or the other, but not both.

"Sometimes they may need NPWT for one part of their body, and a suction pump for another, or they switch from one device to the other after several months," said Bennewith. "To differentiate the criteria would make it more difficult from a healthcare perspective."

In its letter, AAHomecare suggested also applying the new coverage criteria for suction pumps to other LCDs, including those for surgical and ostomy supplies, to further ensure care across the wound care space.

“It is critical for home medical equipment providers and for Medicare patients to have consistent coverage criteria in the wound care space so that patients are able to obtain the preferred wound care device to match their medical needs," the association stated in its letter.