Documentation Checklist: Group 2 Pressure Reducing Support Surface

Although the Center of Medicare & Medicaid Services (CMS) outlines acceptable requirements for a Dispensing Order, Ethos policy requires all necessary criteria to be captured in the form of a Detailed Written Order.

Detailed Written Order

• The date of the order
• The treating physician/practitioner name
• The treating physician/practitioner signature
  1. Handwritten or electronic AND
  2. In accordance with CMS Signature Requirements
     1. Legible full signature OR
     2. Illegible signature over a typed/printed name OR
     3. Other acceptable signatures

• The date the treating healthcare provider signed the order (personally entered by physician)
• A clear, detailed description of the medical device the healthcare team is ordering
• Any changes or corrections have been initialed/signaled and dated by the ordering physician

The medical records collected need to support that the beneficiary meets all of the criteria in one of the situations below:

Situation A

• Multiple (more than one) stage II pressure ulcers located on the trunk or pelvis; AND
• Beneficiary has been on a comprehensive ulcer treatment program for at least the past month (minimum of 30 days) which has included all of the following:
  • Regular assessment by a nurse, physician, or other licensed healthcare practitioner; And
  • Appropriate turning and positioning; And
  • Appropriate wound care on the affected area; And
  • Appropriate management of moisture/incontinence; And
  • Assessment of nutritional status and intervention consistent with the overall plan of care; And
  • Use of an appropriate group 1 support surface; And
  • The chronic wounds have failed to improve over the past month (minimum of 30 days)

OR 

Situation B

• Large or multiple severe pressure ulcers (stage III or IV) on the trunk or pelvis

Situation C

• Recent (within the past 60 days) myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis; And
• The beneficiary was discharged from a hospital or nursing facility within the past 30 days; And
• The beneficiary was on a group 2 or 3 support surface immediately prior to the above discharge

 

NOTE: Coverage following a myocutaneous flap or skin graft is generally limited to 60 days from the date of surgery.