Medicare E0373

Group 2 code

Applies to PressureGuard CFT

Description:

Code E0373 describes an advanced, non-powered pressure reducing mattress which is characterized by all of the following:

1. Height and design of individual cells which provide significantly more pressure reduction than a Group l mattress and prevent bottoming out, and
2. Total height of 5 inches or greater, and
3. A surface designed to reduce friction and shear, and
4. Documented evidence to substantiate that the product is effective for the treatment of conditions described by the coverage criteria for Group II support surfaces, and
5. Can be placed directly on a hospital bed frame.
   

Coverage Criteria:

A group II support surface may be covered if the patient meets the following medical criteria:

• Multiple stage II pressure ulcers located on the trunk or pelvis and patient has been on a comprehensive ulcer treatment program for at least the past month which has included the use of a group I support surface, and the ulcers have worsened or remained the same over the past month OR
• Large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis OR
• Recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days) and the patient has been on a group 2 or 3 support surface immediately prior to a recent discharge from a hospital or nursing facility (discharge within the past 30 days). When a group II support surface is covered following a myocutaneous flap or skin graft, coverage generally is limited to 60 days from the date of surgery.
• If the patient is on a group II surface, there should be a care plan established by the physician or home care nurse which generally should include:
  • 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,
  • Appropriate management of moisture/incontinence,
  • Nutritional assessment and intervention consistent with the overall plan of care.
• Continued use of a group 2 support surface is covered until the ulcer is healed or, if healing does not continue, there is documentation in the medical record to show that: (1) other aspects of the care plan are being modified to promote healing, or (2) the use of the group 2 support surface is medically necessary for wound management.
  

Documentation:

1. An order which is signed and dated by the treating physician must be kept on file. The written order must be obtained prior to delivery of the product.
2. Group II Statement of Ordering Physician.
3. ZX modifier - Since all medical documentation is kept on file and not submitted with the claim, this indicates that the specific requirements found in the Documentation section of the medical policy have been met and evidence of this is available in the supplier's records.

Medical Policy - Description of EO373 - more information can be found at