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2012 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2. Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.23 Wound Care Supplies or Systems : 2.2.23.2 Wound Care System

2.2.23.2
A medically necessary wound care system includes a medical device and its component supplies, and is designed to assist in healing of wounds unresponsive to conventional wound care therapy.
A wound care system may be considered for reimbursement for clients with a Stage III or IV chronic, non-healing wound (such as a pressure, arterial or venous stasis, diabetic ulcer), post-surgical wound dehiscence, non-adhering skin grafts, or surgical flaps required for covering such wounds.
Types of wound care systems include the following:
2.2.23.2.1 NPWT System
NPWT systems and associated supplies (procedure codes E2402 and A6550) are benefits of Home Health Services.
An NPWT system provides and maintains a moist wound environment, and protects the wound during the healing process by sealing it with an adhesive drape and applying continuous or intermittent suction.
An NPWT system consists of a cell foam dressing that is placed in the wound bed, a suction catheter tip, an adhesive drape to cover the wound, suction tubing, and a computerized vacuum pump. An NPWT system uses continuous or intermittent sub-atmospheric pressure to evacuate the excess interstitial fluid and remove growth factor inhibitors. The removal of inhibitors allows the growth factor to stimulate cell proliferation and migration. Removal of excess fluid also helps decrease periwound induration.
Dressing changes associated with an NPWT system are performed every one to three days depending on the amount of exudate produced by the wound. The computerized vacuum pump is rented on a monthly basis. A licensed health-care provider with appropriate training is required to perform an NPWT system dressing change.
2.2.23.2.2 Pulsatile Jet Irrigation Wound Care System
Pulsatile jet irrigation wound care systems (procedure code E1399) are a benefit of Home Health Services for rental only.
A pulsatile jet irrigation wound care system uses antibiotics or water under pressure to irrigate the wound and uses suction to remove the irrigation fluid and debris.
A pulsatile jet irrigation wound care system consists of a pistol-style hand piece with a trigger to control the pulsatile jet. A suction pump is used to remove the fluid. The wound is then dressed using standard wound care supplies.
Dressing changes associated with a pulsatile jet irrigation wound care system are performed every one to three days depending on the amount of exudate produced by the wound. A licensed health-care provider with appropriate training is required to perform a pulsatile jet irrigation wound care system dressing change.

Texas Medicaid & Healthcare Partnership
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