HCPCS code A6402: Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing

## **HCPCS code A6402 documentation requirements** Proper documentation is crucial for justifying the medical necessity of surgical dressings and ensuring reimbursement. Reputable sources outline the following requirements: - Standard written order (SWO): A written order from a physician or other qualified healthcare provider is necessary. This order must include the beneficiary's name, the date of the order, and a general description of the item. - Medical necessity: The documentation must clearly support the use of the dressing. This includes: 1. The type of qualifying wound: Such as a surgical wound, pressure ulcer, burn, etc. 2. Wound details: Information regarding the location, number, and size (length x width) and depth of the wound(s). 3. Wound status: Documentation of the amount of drainage and any other relevant information about the wound's condition. - Dressing use: It must be documented whether the dressing is used as a primary dressing (applied directly to the wound) or a secondary dressing (used to secure a primary dressing). - Frequency and quantity: The documentation should include the frequency of dressing changes and the quantity of dressings needed. Medicare typically has limits, such as a one-month supply at a time, unless there is a specific justification for a larger quantity. - Ongoing evaluation: The treating practitioner should conduct regular evaluations (e.g., weekly or monthly) to assess the wound's healing progress and adjust the dressing type or frequency as needed.

## **A6402 billing requirements** Although Medicare provides reimbursement due to the surgical dressings benefit, which is a part of the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), billing for HCPCS code A6402 still involves specific rules and considerations, particularly for Medicare and other payers. Here's a list of them. - Qualifying wounds: The dressings are covered when they are required for the treatment of a wound caused by, or treated by, a surgical procedure, or for a wound that has been debrided. - Frequency limits: For non-impregnated gauze dressings without a border, the usual dressing change frequency is up to three times per day. It's generally considered not necessary to stack more than two gauze pads in one area. - Bundled services: If a healthcare practitioner applies the surgical dressing as part of a professional service that is billed to Medicare, the dressing is considered "incident to" the professional service and is not separately billable. Claims for the dressings themselves should not be submitted in this scenario. However, if dressing changes are sent home with the beneficiary, the claims for these dressings may be submitted. - Billing units: The billing unit for A6402 is "each dressing." This means if a patient uses two 4"x4" pads per dressing change and changes the dressing three times a day, the total billed quantity would be six units per day. - Supplies to secure the dressing: Because A6402 is for a dressing without an adhesive border, medical tape (HCPCS code A4450 or A4452) or other conforming bandages may be billed separately to secure it, as long as it is medically necessary.

## **Other relevant codes** - A6403: Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing - A6209: Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing - A6232: Gauze dressings, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in. - A6197: Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing - A6253: Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing