TWC 2023 Year in Review

Are providers missing the diagnosis of PG because they are anchoring on “positive” biopsy findings? Could we be missing cases in which PG patients underwent amputation, didn’t have a recurrence, and were never diagnosed? Or are we just not talking about amputation in pyoderma gangrenosum? In January, Shannon Kody, MD, and Alex G. Ortega-Loayza, MD, MCR explored these questions.

“The next time a DME company calls and asks for more information from the chart or explains that there is a problem with what you recorded, keep in mind that if clinicians are not meticulous about the documentation, it’s the DMEs who will pay back money because of it, and your patients will not be able to get the dressings they need,” argued Caroline E. Fife, MD, FAAFP, CWS, FUHM, in her February editorial.

“I chose to make my practice mobile, which allows me to bring advanced wound and ostomy care to the patient. I saw the need for this since the beginning of my nursing career. Many patients cannot leave their homes even for basic health care needs,” said Laura Kaiser, RN, MSN, APRN-BC, CNS, WOCN, of her home-based wound care practice.

What is the future of CLTs in outpatient lymphedema clinics? Frank Aviles Jr., PT, CWS, FACCWS, CLT-LANA, ALM, AWCC, DAPWCA; and Brandy McKeown, OTR/L, CLT-LANA, CLWT explored the Lymphedema Treatment Act and its implications.

Applying a circumferential lower extremity NPWT dressing is challenging. Sandra Wainwright, MD found a better way that reduces the time and the number of people required to get the job done.

“It is hard to understand how demoralizing it is. Lipedema affects your entire life, starting in the teenage years,” noted Dr. Fife in a March editorial.

In the fourth installment of their series on hyperbaric oxygen therapy indications, Denise Nemeth, MPAS, CWS; and Jayesh B. Shah, MD, MSc, UHM ABPM, CWSP, FAPWCA, FCCWS, FACHM FUHM, FACP, discussed HBOT for compromised skin grafts and flaps.

“Patients of any race, especially at-risk minorities with multiple and/or larger wounds, must not be discriminated against by a bundled policy that restricts the treatment of larger wounds or policies that unreasonably restrict number of applications,” Shaun Carpenter MD, CWSP, WMS argued in an April editorial.

In an April Business Briefs column, Kathleen D. Schaum, MS, expounded on the multiple inquiries from wound/ulcer management professionals and manufacturers who want to know if a new CTP for skin wounds was, or will be, assigned a HCPCS “Q” code, rather than a HCPCS “A2XXX” code.

In a June podcast, Morgan McCoy and Caroline Fife, MD, discussed Morgan's wound care experience after a lower extremity amputation, and what physicians need to know about providing the best experience for their patients.

In a video following her SAWC Spring presentation, Jeanine Maguire, PhD, MPT, CWS, discussed the challenges in helping patients navigate transitions in care, what providers do right and what they do wrong, and discussed the Wound Provider Checklist developed by the Post-Acute Wound and Skin Integrity Council.

In the light of originally proposed changes to CTP reimbursement, Kathleen D. Schaum, MS, cautioned that the stakeholders who apply CTPs to Medicare beneficiaries in the affected states must act quickly to educate the pertinent professionals and revenue cycle team members and to refine their product selection, utilization, documentation, and coding processes.

To ensure continued success for wound care practices, Donna J. Cartwright, MPA, RHIA, CCS, RAC, FAHIMA, advised stakeholders affected by originally proposed new LCDs and LCAs to review and refine their documentation of skin substitute/CTP applications.

Audits may be unavoidable in the wound clinic. In an August podcast, Helen B. Gelly, MD, FUHM, FACCWS, UHM/ABPM; and Caroline E. Fife, MD, FAAFP, CWS, FUHM discussed audits they've been involved in and what you need to do to prepare.

Following a September decision, Marcia Nusgart, RPh, explained the withdrawal of the proposed LCD on Skin Substitute Grafts/Cellular and/or Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers.

Supplemental Medical Review Contractor audits are here to stay and until medical necessity and documentation gets better, expect to see an increase in audit activity. Michael Crouch, CPC, CPMA, wrote about how to respond to a "smirk" audit, the appeals process, lessons learned, and compliance recommendations.

Following the November release of the 2024 OPPS and MPFS Final Rules, Kathleen D. Schaum, MS, provided the correct payment information regarding CTPs and a brief overview of the 2024 allowable rates for other common wound/ulcer management procedures and services.

As 2023 ends, TWC board members shared the clinical and reimbursement challenges they faced this year, with an eye toward a better 2024.