Clinician’s Report: Biofilm Care

Lohmann & Rauscher (Milwaukee, WI) 

Contact Information: www.lohmann-rauscher.us; 855-892-4140; inquiries@us.LRmed.com 

What is your most recent antibiofilm product? Debrisoft^® and Debrisoft Lolly

How can the product be obtained for use in the outpatient wound clinic? All main distributors (Owens Distributors, Sanford, FL; Cardinal Health,^TM Dublin, OH; McKesson, San Francisco, CA; Henry Schein,^® Melville, NY; Medline Industries, Mundelein, IL; Patterson^® Companies Inc., Mendota Heights, MN).

How does the product function? Debrisoft uses a monofilament fiber technology with 18 million fibers cut in a specific angle and length. It’s a gentle, safe, precise method of debridement. It lifts, binds, and removes superficial slough and debris (including biofilm), whereas new granulation tissue and epithelial cells are protected. Debrisoft Lolly is for the debridement of deep wounds and hard-to-reach areas, and Debrisoft Pad is for superficial wounds and surrounding skin. 

How’s the product used? The fleecy side of the Debrisoft Pad (20-40mL) or the fleecy head of the Debrisoft Lolly (5-15mL) need to be fully moistened with tap water or saline solution, depending on local guidelines. Gently, with light pressure, the soft, fleecy part of the moistened Debrisoft is used in a circular motion on wounds or in long, sweeping strokes on the skin. Debrisoft is a fast, effective, almost painless method of debridement, producing rapidly visible results in 2-4 minutes, saving time and money.

Approximately how much does the product cost? One piece costs between $15-$20.

Is there anything to discuss as far as coding and reimbursement? Current Procedural Terminology (CPT) codes 97957 or 97602. 

Alliqua BioMedical (Yardley, PA) 

Contact Information: https://alliqua.com; 844-963-2273; productinfo@alliqua.com

What is your most recent antibiofilm product? UltraMIST (from the family of MIST^® Therapy products) provides noncontact, low-frequency ultrasound delivered through a saline mist to the wound. 

How can the product be obtained for use in the outpatient wound clinic? Purchase is conducted through Alliqua. There are two components to the UltraMIST System. This includes the generator/base unit and a sterile, single-use, disposable applicator that fits onto the treatment wand, so that the ultrasound tip is exposed. The built-in saline tubing allows for easy setup. Applicators are packaged in individual sterile pouches, with six per dispenser box. 

How does the product function? The ultrasound wave energy gently places mechanical stress on the cell membrane. The stress stimulates cellular communication, improving blood flow and increasing fibroblast and growth factor release. It reduces the amount of bacteria within and below the wound bed. Bacterial cells are more rigid and susceptible to micromechanical stress. When treated with MIST Therapy, bacterial membranes rupture and die. The mechanical stress breaks apart biofilm structures, providing access to the wound bed and an improved healing effect. 

How’s the product used? UltraMIST is used in wound management protocols across a range of healthcare settings dependent upon the needs of the individual patient and the clinical setting. Treatments are commonly administered by trained healthcare professionals certified on the equipment and proper treatment techniques. The frequency of UltraMIST treatments is subject to clinical decision, but is usually provided 2-3 times per week for an average of 5-6 weeks (15-18 treatments). Observable, documented improvements in the wound(s) should be evident after two weeks or six treatments. Recommended treatment is 2-3 times per week. The length of individual treatments will vary per wound size, according to manufacturer recommendations.

Improvements include:

• reduction in pain, inflammation, and/or edema/induration;
• improved granulation tissue; and
• decreased wound size and/or wound volume.

Approximately how much does the product cost? There are pricing protocols available to customers that include equipment purchase or monthly rental fees along with volume-based applicator prices. 

Is there anything to discuss as far as coding and reimbursement? There is a reimbursement amount for outpatient use of MIST Therapy, making the treatments revenue positive, or at least neutral. The CPT code is 97610 for low-frequency, noncontact, nonthermal ultrasound, including topical application(s) when performed, wound assessment, and instruction(s) for ongoing care, per day. 

IntraDerm^TM Pharmaceuticals (Petaluma, CA) 

Contact Information: https://intraderm.com; 855-317-1107; jday@intraderm.com

What is your most recent antibiofilm product?
ALEVICYN^™ Dermal Spray

How can the product be obtained for use in the outpatient wound clinic? Local pharmacies and specialty pharmacies. 

How does the product function? The hypochlorous acid in Microcyn, similar to the natural hypochlorous acid produced by the human body, preserves the Microcyn solution. Microcyn solution aids in the mechanical removal of debris and foreign materials from the application site. Dirt debris and foreign material are mechanically removed by the action of the wound cleanser moving across the wound bed or application site, with or without the assistance of a suitable wound dressing. 

How’s the product used? ALEVICYN Dermal Spray, under the supervision of a healthcare provider, is intended for the cleansing, irrigation, moistening, debridement and removal of foreign material, including microorganisms and debris from exudating wounds, acute and chronic dermal lesions (including stage I-IV pressure ulcers), stasis ulcers, diabetic ulcers, post-surgical wounds, first- and second-degree burns, abrasions, minor irritations of the skin, diabetic foot ulcers, ingrown toenails, grafted/donor sites, and exit sites.

Approximately how much does the product cost? No more than $30 for insured patients and no more than $45 for all other patients. 

Is there anything to discuss as far as coding and reimbursement? Not at this time. 

Crawford Healthcare (United Kingdom) 

Contact Information: www.crawfordhealthcare.com; info@crawfordpharma.com

What is your most recent antibiofilm product? KerraContact^TM Ag Dressing

How can the product be obtained for use in the outpatient wound clinic? KerraContact Ag dressings can be obtained through traditional medical supply distribution channels or by ordering directly at 855-522-2211.

How does the product function? The KerraContact Ag Dressing is a contact layer that contains Ag Oxysalts™ Technology, which has a unique chemistry — three missing electrons make it significantly more reactive when in contact with wound fluid and up to six times more powerful than traditional silver compounds. The increased reactivity leads to a quick, 99.999% killing of bacteria (including superbugs) and the ability to break through biofilm to kill the bacteria within. 

How is the product used? The KerraContact Ag Dressing is a contact layer that can be applied directly to the wound bed and covered with an absorptive dressing.

Approximately how much does the product cost? The KerraContact Ag Dressing is priced competitively versus other silver contact layers in the market.

Is there anything to discuss as far as coding and reimbursement? The KerraContact Ag Dressing is classified as a contact layer with Pricing, Data Analysis and Coding, and has been awarded codes A6206, A6207, and A6208. 

Progressive Wound Care^® (Savannah, GA) 

Contact Information: https://progressivewoundcare.com; 912-401-3234

What is your most recent anti-biofilm product? IodoFoam^® controlled-release iodine (foam dressing)

How can the product be obtained for use in the outpatient wound clinic? 

• Outpatient prescription (patient orders/home deliveries) distribution options: Advanced Tissue (Little Rock, AR), Edgepark^® Medical Supplies (Twinsburg, OH), Mercy Surgical Dressing Group (Alpharetta, GA), Prism Medical Products (Elkin, NC).
• Clinics and hospitals: Direct from Progressive Wound Care, Independence Medical (Cleveland, OH), Mercy Surgical Dressings. 

How does the product function? IodoFoam is a highly absorbent foam dressing, complexed with iodine to provide sustained microbial/biofilm control. The IodoFoam dressing turns from jet black to white when the iodine has been depleted (indicating time for dressing change). IodoFoam’s proprietary controlled/slow release of iodine (Ioplex^® Technology) improves biofilm kills while lowering the cytotoxicity of iodine to a level equivalent to competing silver dressings. 

How is the product used? IodoFoam is placed directly in contact with the wound bed and secured with a secondary dressing appropriate to exudate level. IodoFoam is changed when the black color fades to off-white. IodoFoam may be applied in double or triple layers when placed under compression wraps that are changed weekly to increase the reservoir of iodine for weekly changes. 

Approximately how much does the product cost? IodoFoam is reimbursable by Medicare and priced accordingly, respective of the clinical setting and purchase volumes.

Is there anything to discuss as far as coding and reimbursement? IodoFoam is reimbursable by Medicare and is Healthcare Common Procedure Coding System coded A6210.