Hi Kim,

Just a question to clarify…are you asking the question so as to assign a correct ICD 10 code? Or to qualify a patient for a service, such as HBO? Or because ???

Thanks..that will help us determine who should answer this…

Thanks!

Cathy Milne

The patient had been cleared to begin HBO as Diabetic Wound, Wagner 3. Had surgery with ray and toe amputation. The Director thinks "no open wound" would mean the patient doesn't have the reason for treatment. The surgeon wanted to know if he should leave part of the surgical site open. I think that the surgery is doing what CMS asked for, removal of nidus of infection, and that a sutured wound is not a healed wound and is just part of the surgical managment...and is it going to stay sutured. So, could we proceed with hyperbaric therapy, and would the Wound ICD10 still be appropriate? Thanks!

Kim: Great question! I’m going to ‘attempt’ an answer … and I suspect other medical directors will agree/disagree.

The answer is … “It depends.” Primarily, it depends on what description that your Medicare fiscal intermediary puts to Wagner Grade 3 DFU. And, it depends on the ‘story’ that your physician told in the documentation prior to surgery.

From what I read above, you’ve told a story that has the nidus of infection removed via the ray amputation and a closed surgical incision. In my opinion, the DFU is now gone. Nothing to treat with HBOT.

In the FI world that I was part of … the DFU definition started with … ulcer to bone or joint with failure of healing using standard wound care for at least 30 days. So, surgical intervention stopped the clock.

This is not difficult for us in wound care — I wanted to treat these patients as DFU. BUT, on audit, these would fail and the FI could consider this as Medicare fraud/abuse.

gene

Hi Dr. Worth,
I always like to read your opinions, invariably launched with "it depends".
Thank you, I learned something today!

Thanks for the kind words.

Brief answer. Surgically closed is closed.

On the other hand, excising the ray and leaving the resulting wound open only solves a small part of the problem. In my book, surgery restarts the clock.

Gene