|
24.5.23.2 Decubitus Care Accessories
A bed blanket cradle (keeps bed covers from touching affected skin) may be considered for reimbursement when documentation supports medical necessity (e.g., diabetic ulcers, decubiti or burns, or gouty arthritis).
A heel or elbow protector may be considered for reimbursement when documentation supports medical necessity.
The staging of pressure ulcers used in this policy is as follows:
Stage I: Observable pressure related alteration of intact skin whose indicators are as follows:
• Compared to the adjacent or opposite area on the body may include changes in one of more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel) and/or sensation (pain, itching).
•The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue or purple hues.
Stage II: Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.
Stage III: Full thickness skin loss involving damage to, or necrosis of, SQ/SC tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
Stage IV: Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage IV pressure ulcers.
Bed rails and frames that have been purchased are anticipated to last a minimum of 5 years and may be considered for replacement when 5 years have passed and/or the equipment is no longer functional and no longer repairable. The durable medical equipment may then be considered for prior authorization. Replacement of equipment will also be considered when loss or irreparable damage has occurred. A copy of the police or fire report when appropriate, and the measures to be taken to prevent reoccurrence must be submitted.
In situations where the equipment has been abused or neglected by the client, the client's family, or the caregiver, a referral to the DSHS THSteps Case Management unit will be made by the Home Health Services prior authorization unit for clients under 21 years of age. Providers will be notified that the State will be monitoring this client's services to evaluate the safety of the environment for both the client and equipment.
|
