ORTHO-TEC MEDICAL, INC. WOUND MANAGEMENT AND SPECIALTY REHABILITATION PRODUCTS
Specialty Support Surfaces - Group I Qualification Criteria
A Group 1 mattress overlay or mattress (E0181-E0189, E0196-E0199, and A4640) is covered if one of the following three criteria are met:
- The patient is completely immobile - i.e., patient cannot make changes in body position without assistance, or
- The patient has limited mobility - i.e., patient cannot independently make changes in body position significant enough to alleviate pressure and at least one of conditions A-D below, or
- The patient has any stage pressure ulcer on the trunk or pelvis and at least one of conditions A-D below. Conditions for criteria 2 and 3 (in each case the medical record must document the severity of the condition sufficiently to demonstrate the medical necessity for a pressure reducing support surface):
a. Impaired nutritional status
b. Fecal or urinary incontinence
c. Altered sensory perception
d. Compromised circulatory status
Patients needing pressure reducing support surfaces should have a care plan which has been established by the patient's physician or home care nurse, which is documented in the patient's medical records, and which generally should include the following:
- Education of the patient and caregiver on the prevention and/or management of pressure ulcers.
- Regular assessment by a nurse, physician, or other licensed healthcare practitioner.
- Appropriate turning and positioning.
- Appropriate wound care (for a stage II, III, or IV ulcer).
- Appropriate management of moisture/incontinence.
- Nutritional assessment and intervention consistent with the overall plan of care. For more info on our Air Mattress Medical Beds please see our PDF File: http://www.orthotecmedical.com/otm-instant-inservice.pdf
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