How To Use HCPCS Code A6198

HCPCS code A6198 describes a specific type of wound dressing known as alginate or other fiber gelling dressing. This dressing is used to cover wounds and promote healing. In this article, we will explore the details of HCPCS code A6198, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS A6198?

HCPCS code A6198 is used to identify alginate or other fiber gelling dressings that are sterile and have a pad size larger than 48 square inches. These dressings are specifically designed to manage wounds and promote healing. They are made from natural fibers, such as seaweed-derived alginate, which forms a gel-like substance when it comes into contact with wound exudate. This gel helps to create a moist wound environment, which is conducive to healing.

2. Official Description

The official description of HCPCS code A6198 is “Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing.” The short description is “Alginate dressing > 48 sq in.”

3. Procedure

1. Cleanse the wound using an appropriate wound cleanser or saline solution.
2. Select an alginate or other fiber gelling dressing with a pad size larger than 48 square inches.
3. Apply the dressing directly to the wound, ensuring that it covers the entire wound surface.
4. Secure the dressing in place using medical tape or a bandage.
5. Monitor the dressing regularly and change it as needed, following healthcare provider instructions.

4. When to use HCPCS code A6198

HCPCS code A6198 should be used when a healthcare provider applies an alginate or other fiber gelling dressing with a pad size larger than 48 square inches to a wound. This code is typically used for larger wounds that require a larger dressing to adequately cover the wound surface. It is important to note that the use of this code is subject to any special coverage instructions that may apply.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A6198, healthcare providers should ensure that the following documentation requirements are met:

• Medical record documentation supporting the medical necessity of the dressing.
• Documentation of the wound size and location.
• Documentation of the type of dressing used and the pad size.
• Date of service and duration of dressing application.

6. Historical Information and Code Maintenance

HCPCS code A6198 was added to the Healthcare Common Procedure Coding System on January 01, 1997. It has an effective date of January 01, 2009. No maintenance actions have been taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code A6198 is subject to carrier pricing, meaning that the pricing for this code is determined by the individual carrier. It falls under the category of surgical dressings or other medical supplies. Medicare and other insurance providers may cover the cost of alginate or other fiber gelling dressings when they are medically necessary for wound management. However, coverage may vary depending on the specific insurance plan and medical necessity criteria.

8. Examples

Here are five examples of when HCPCS code A6198 should be billed:

1. A patient with a large, non-healing wound on their leg receives an alginate dressing with a pad size of 60 square inches.
2. A post-operative patient with a surgical wound measuring 50 square inches receives an alginate dressing for wound management.
3. A patient with a chronic pressure ulcer measuring 70 square inches receives an alginate dressing to promote healing.
4. A patient with a traumatic wound measuring 55 square inches receives an alginate dressing as part of their wound care regimen.
5. A patient with a diabetic foot ulcer measuring 65 square inches receives an alginate dressing to facilitate wound healing.