APWCA News

Novitas Solutions, Inc. is the Medicare contractor (MAC) for the following states and district:

Arkansas
Colorado
Delaware
District of Columbia
Louisiana
Maryland
Mississippi
New Jersey
New Mexico
Oklahoma
Pennsylvania
Texas

In January 2017, Novitas published a proposed rule for payment of wound care treatments to their beneficiaries which we thought was filled with many inconsistencies and confusion with aspects that did not seem to be based on the current state of wound care delivery by the wound care industry (many of whom are members of the APWCA). This proposed rule was subject to a 60 day comment period. APWCA, in conjunction with the Alliance of Wound Care Stakeholders, spoke on behalf of its Novitas members and submitted comments. Our voice was heard!

Novitas has just published their recently finalized LCD (Local Coverage Determination) L35125 entitled "Wound Care" which is due to go into effect on November 11, 2017. A copy of the entire LCD L35125 is available here. This update to membership is meant to review key points of the finalized LCD.

1. Surgical/excisional debridement of dermis, subcutaneous tissues, and fascia: There is no limit to the number of surgical debridements a patient may receive in a 360 day time frame. However, Novitas feels that greater than 8 debridements at any depth is "excessive". Therefore, the LCD states that should the patient require greater than 8 total debridements, "meticulous" documentation is necessary to explain why this "excessive" amount of debridement is indicated. Please keep in mind that providers should already be documenting medical necessity with each and every debridement. Please take this opportunity to review your documentation habits.
2. Surgical/excisional Muscle/fascia and bone debridement: Novitas feels that more than 5 total debridements that include muscle/fascia or bone in a 360 day period is "excessive" but will not place an "a priori" limit. Instead the LCD requires that more than 5 total debridements that include muscle/fascia or bone in a 360 day period be accompanied by "meticulous" documentation illustrating that the service is both medically reasonable and necessary.
3. Non-contact non-thermal Ultrasound for wound treatment (MIST): The LCD states it should be offered a minimum of 2-3 times per week. But, if no observable wound improvement is noted after 2 weeks (4-6 treatments), then this wound treatment is not reasonable or necessary. Furthermore, no more than 18 treatments in a 6 week period will be considered reasonable or necessary.
4. Negative Pressure Wound Therapy (NPWT): Two types are considered: a) that done with DME, and b) that done with disposable systems as an outpatient or homecare patient. Both are covered given proper indications and usage. The LCD states, "…the beneficiaries who undergo treatment utilizing negative pressure wound therapy, only a minority appears to require more than 6 NPWT services in a 120 day period to accomplish the desired objective of the treatment plan of the wound. Only when medical necessity continues to be met and there is documented evidence of clear benefit from the NPWT treatment already provided, should NPWT services be continued beyond this frequency or time frame."

There were numerous changes from the proposed LCD to the final LCD which was just published. The changes relevant to our comments include:

1. No frequency limit on total number of debridements in a year
2. No frequency limit on the total number of debridements including muscle / fascia and bone in a year
3. Disposable NPWT coverage was not removed as was proposed
4. Wound photography not required as proposed (but it is suggested especially when more than 8 total debridements or 5 debridements including muscle / fascia and bone are performed in a year)
5. Palliative wound care is covered
6. The statement in the proposed LCD that a wound needs to show a documented improvement of 10% per month or granulation tissue progression of 1 mm per month was removed

ICD-10 codes that start with L97- are used for non-pressure chronic ulcers of the lower limb. These codes are used for diabetic foot ulcers, stasis ulcers, and others. Since the onset of ICD-10, there were only five 6^th character options for these L97- codes. These were:

1 – limited to breakdown of skin
2 – with fat layer exposed
3 – with necrosis of muscle
4 – with necrosis of bone
9 – with unspecified severity

These did not leave the option to indicate with our codes that an ulcer had muscle exposed without necrosis of muscle or bone exposed without necrosis of bone. The APWCA worked with the Alliance of Wound Care Stakeholders to write to the World Health Organization (WHO) and explain this gap in code options and request that more options be created that would allow us to code these scenarios accurately.

Our efforts have been recognized! The WHO has announced new 6^th character options that can be used with all L97- codes. These go into effect October 1, 2017.

The following 6^th character options are being added:

5 – with muscle involvement without evidence of necrosis
6 – with bone involvement without evidence of necrosis
8 – with specified severity NEC

These new 6^th characters of “5” and “6” allow the option to indicate the ulcer is to the depth of muscle or bone without necrosis at that depth. The new 6^th character of “8” should be used if the severity of the ulcer is specified in the documentation, but none of the 6^th character options of 1-6 are appropriate.

These new 6^th characters can be used with any code that begins with L97-.

Note: Any ICD-10 code listed above that ends with a “-“ is not complete and requires more characters to complete the code.

Nothing discussed in this communication guarantees coverage or payment. The existence of an ICD-10 code does not ensure payment if it used. Coverage and payment policies of governmental and private payers may vary from time to time and in different parts of the country. Questions regarding coverage and payment by a payer should be directed to that payer. APWCA does not claim responsibility for any consequences or liability attributable to the use of any of the codes discussed in this communication.

Thank you to all participants of the APWCA 2017 National Clinical Conference for helping make this year’s educational program a huge success! With almost 400 in attendance, 75+ presentations, standing room only review course, and a sold-out exhibit hall, this year’s meeting exceeded all expectations.

Presentations are available online for public viewing until September 30 http://www.apwca.org/2017-Presentations. Beginning October 1, educational content will be available to members only.

SAVE THE DATE and join us September 6-8, 2018 in Baltimore, MD for next year’s conference.

Masters Award (MAPWCA) Recipients: E. Cuauhtémoc Sánchez, MD; Cheryl M. Bongiovanni, PhD; Charles Andersen, MD; Tyler Sexton, MD; Randall Cook, MD; Steven Sprigle, PhD, PT along with President (L) Steven Kavros, DPM; Vice President (R) Jeff Niezgoda, MD and Conference Chairs Kathya Zinszer, DPM and Barbara Delmore, PhD, RN

APWCA was well-represented at the recent New Cardiovascular Horizons (NCVH) Annual Conference held in New Orleans on May 31-June 2. Steven Kavros, DPM, MAPWCA, FACCWS, CWS, APWCA President, presented excellent content during the Podiatry and Wound Care sessions including "Treatment of Ischemic Wounds with Non-Contact, Low-Frequency Ultrasound: The Mayo Clinic Experience" (View PDF) and "Improving Wound Healing Outcomes Using Hypocholorous Solution as a Therapy" (View PDF). He also participated in the NCVH Interview Arena to promote the upcoming APWCA National Clinical Conference, September 7-9, in Philadelphia, PA. 

This document provides the quality benchmarks and standard deviations for each quality measure that may be included in the Performance Year 2016 Quality and Resource Use Reports and used in the calculation of the 2018 Value Modifier. There are four types of quality benchmarks that may be used to calculate a TIN’s Quality Composite Score for the 2018 Value Modifier: 

1. CMS-Calculated Outcome measures (Table 1) 
2. Physician Quality Reporting System (PQRS) measures (Table 2) 
3. Electronic Clinical Quality measures (eCQM) reported to the PQRS (Table 3) 
4. Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures (Table 4) 

Starting with the 2018 Value Modifier, separate benchmarks will be used for eCQM and non-eCQM PQRS measures. The benchmarks for each quality measure are based on the performance of all solo practitioners and groups nationwide in 2015, the year prior to the performance period. The benchmarking and measure calculation methodology is described at the end of this document. 

Download full document from CMS here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/PY2016-Prior-Year-Benchmarks.pdf

The APWCA Board of Directors has reviewed the new NPUAP staging system. Additionally, we have reviewed responses from allied professional organizations, which have included commentary in support of as well as opposition to the new nomenclature presented by the NPUAP.  The Board applauds the dedication and the continued effort that the NPUAP has consistently delivered to enhance and promote the quality of care provided to patients with pressure ulcers.  The APWCA is confident that all issued statements and positions are well intended and primarily founded on patient centric motivations.  

The APWCA is devoted to the best practice clinical algorithms, which include regulatory and policy guidance.  As an organization committed to evidence-based best practice, we recognize that clinical standards, policy and nomenclature will change over time. Evolution in medicine and wound healing is based on new evidenced-based science, novel technology and an improved understanding of wound healing physiology.  

The APWCA is a membership-based organization with thousands of talented and skilled wound healing experts.  To issue a position statement without allowing our membership the opportunity for discussion and debate on this important topic would be inconsistent with the core principles of the APWCA.  As an organization, we plan to fully explore and deliberate the changes in the very near future.  Once we have accomplished our due diligence and allowed our membership to voice their opinions, we will join our colleagues and sister professional societies and issue a position statement. The APWCA will attempt to provide positive feedback and suggestions to improve and enhance the NPUAP staging system. In order to accomplish this goal, the APWCA Board of Directors will be sending a survey to all of the members to query your feedback on this important topic.

Click here to view/download our full position statement.

Sincerely,

Steven J. Kavros, DPM, MAPWCA, FAACWS, CWSP
President
American Professional Wound Care Association

American Professional Wound Care Association (APWCA) invites the submission of research abstracts for the 16th Annual APWCA National Clinical Conference, which will take place September 7-9, 2017 at the Loews Philadelphia Hotel, Philadelphia, PA.

Submission Categories:

• Wound Healing
  
• Limb Salvage
  
• Hyperbaric Oxygen Therapy
  

To submit an application or for additional information about abstract format and guidelines, visit http://www.apwca.org/2017-Abstracts

The deadline for submission is Tuesday, August 1, 2017

If you have questions about abstract submission, please contact APWCA at 337.541.2240 or abstracts@apwca.org

LAFAYETTE, LA — American Professional Wound Care Association (APWCA) President, Steven J. Kavros, DPM, MAPWCA, FAACWS, CWSP, recently presented wound care content at the inaugural New Cardiovascular Horizons (NCVH) Minneapolis meeting on October 8. The day-long meeting, entitled Clinical Updates and Advances in Vascular Medicine, was held at the Hyatt Regency Minneapolis. Dr. Kavros also served as moderator for the session. The session, entitled Essentials in Wound Care, was offered by NCVH in partnership with the APWCA and included Improving Wound Healing Outcomes Using Hypochlorous Solution as a Therapy, Hyperbaric Oxygen in the Outpatient Setting and Peripheral Arterial Disease and Chronic Venous Insufficiency Awareness: Essential to Healing Wounds. Copies of the session content are available for viewing here.

About APWCA

The American Professional Wound Care Association® (APWCA) is a non-profit medical association welcoming medical providers from all disciplines involved in prevention and treatment of difficult wounds. Through a synergy of disciplines, APWCA has been a worldwide leader in the prevention and treatment of acute and chronic wounds since 2001. This association provides an informational and educational forum for healthcare providers, while promoting excellence in wound care and patient advocacy. Learn more about APWCA at www.apwca.org.

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