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Yes you are right, it is untimed code. There are two G code for E-stim, G0283 untimed code, not to be used for wound care. G0281 is for wound care. CMS use G codes as temporay code until they can assign specific code such as 97032 ( e-stim timed)

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Well, let's start from the beginning. An Unna Boot is a gauze bandage that is impregnated with zinc oxide or calamine. It is wrapped from the base of the toes to just below the knee. The purpose of this bandage is to offer compression to the leg to get fluid out to allow wound healing in legs that have swelling. It is used for venous leg ulcers---not generally diabetic ulcers. To give you more information, I would need to know the exact location of the ulcer or wound as well as what the wound looks like and additional information. The potential problem with diabetic ulcers is that they are often complicated by poor circulation in which case an Unna Boot may not be appropriate and could cause additional harm.

I hope that this is helpful.

April Kuhlman, RN CWOCN

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Hi Monica:

Unna boots are not usually recommended for diabetic wounds because most diabetics have macrovascular disease. In the case that a Pt’s circulation is compromised more damage can be done by applying a unna boot. Obtaining an ABI (ankle brachial index) is recommended before applying compression dressings like an unna boot. The ABI value calculated by Dividing Ankle Systolic pressure by Brachial systolic pressure is usually falsely elevated in diabetics because of calcifications in the vessels. Example: If a patient without disease (diabetes, atherosclerosis, CAD etc) has a ABI of 1.0 then one can safely assume that the patient has good arterial circulation and can tolerate compression therapy. Diabetics’ ABI values are usually falsely elevated—if the practitioner is not aware of this they can ignorantly apply an unna boot to a Pt’s limb which may or may not cut off circulation leading to rapid deterioration of the existing wound and possible gangrene. It is really good to take a comprehensive wound care course if you are a practitioner or are involved in treatment decision making. Refer the Pt. for a vascular consult before attempting any aggressive treatment such as an unna boot or four layer compression. Some Practitioners may feel comfortable applying an unna boot for a diabetic wound with edema and venous compromise--- if adequate vascular studies are obtained, if the patient is able to learn about wearing an unna boot and can participate in care (such as being able to remove unna boot if a problem arises), can be closely monitored—requires more frequent f/u by clinician. There are many treatment options for a diabetic ulcer—so an unna boot may not need to be considered in this instance. If you have any questions feel free to e-mail me at j.b.pinnock@att.net.

Best Regards,

Jamie Pinnock, R.N., CWCN

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For Monica: Unna boots are a treatment for venous ulcers and edema. Diabetic foot ulcers (with grades, not stages) typically have some degree of arterial compromise, which is a contraindication for compression. For diabetic ulcers, the key treatment points are debridement, off-loading, vascular supply, bioburden control, and moist wound healing. Unna boots are not appropriate.
Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS

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I would consider pulsatile lavage over whirlpool in any setting but especially in the home. The issue with whirlpool for leg ulcers is putting a leg that may be edematous in a dependent position and adding warm fluid when can cause further maceration as well as an increase in edema since the warm water will cause dilation of the blood veseels leading an increase in capillary leakage.

However, I would consider an enzymatic debriding agent over pulsatile lavage or in combination.

Thanks April Kuhlman RN CWOCN

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In my years of wound life I have not heard a whirlpool for home use. Mainly because whirlpool requires drainage system to drain water and clean. How about using a pulse lavage? ot water pik

Dex PT

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Most medical supply houses should stock these. We use Gulf South or Direct supply.
de rn

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You are most likely referring to the 3 mL or 5 mL vials. These are generally manufactured for use for respiratory purposes and would therefore be found at any medical supplier that sells respiratory supplies.

I have looked into using these as well but you pay much more for the packaging. Our home care agency usings 110 ml bottles and discards then every 24 hours. This is actually more cost efficient if more than 2 vials are used in a 24 hour period.

April RN CWOCN

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1-800-MEDLINE www.medline.com

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Medline offers them, as well as Tristate Surgical. I know that Medline is National, Tristate may have an office out that way.
Sonja Whittredge RN, WCC

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Look up saljet online

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If you do Unna boot on each leg I would say it would be justifiable to charge each leg. However it depends on the insurance. If the patient is medicare B, you might want to check if the Unna boot CPT code is timed or untimed. If it is untimed and the patient is Medicare B then no matter how many minutes you spend for application of Unna boots to both legs you should bill 1 unit. If it is time code then you bill 1 unit every 15 minutes you spend to apply the Unna boots. As far as I know Modifier is use for billing Medicare part B only. Thanks

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Re: Unna boot billing: Talk with your fiscal intermediary, as they vary a bit in their rulings.
Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS

I cannot stress this enough. Any wound that has been present for more than 1 year (some of the newer research says 3 months) should be biopsied to rule out a malignancy (cancer) and try to determine the cause. I would first find a doctor that is willing to biopsy the wound and go from there. By the way, the wound VAC is not recommended for wounds that may be cancerous.

Thanks

April RN CWOCN

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The vac is still a good choice. When and if pain developes you need to lessen the pressure. It is probably set at 125, if you cut this back he should be without pain. Contact KCI support and they will be glad to help with the concern. They are open 24/7.
You didn't say what type and stage of wound he had. Oasis is also a good product and can be used with an unna boot. I have had very good results with this also. The unna boot should be changed2-3 times a week but the oasis doesn't need changed more than monthly.
de RN

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Try hydrofera blue wound dressing
Info available online

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Hi, I am not a wound care specialist but I am on the Board of The BTERFoundation.org I am a former patient of maggot therapy. I know it may sound gross but needless amputation or having chronic ulcers or wounds for years is gross, also. My doctors had tried almost everything to heal my foot ulcers, over a two year period, at a cost of approx. $40,000. Nothing worked. ( I am a 43 year diabetic on immunosuppressants after kidney transplant) Medical maggots worked in a period of a few months and cost about $100.00 a treatment. They are sterilized JUST for this purpose, they eat just the dead infected tissue, they kill all the bacteria, and they excrete enzyme to promote healing. Please check out our website and get more information. As information is "Power" being my own patient advocate saved my feet from amputation.

Good Luck
Pamela Mitchell
Patient Advocate
BTER Foundation

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Yes, you should be able to do wound care without a MD being in house. I haven't heard of any state that prohibits this. Do you not have wound protocals approved by the medical director. If not you definately need this to cover you and of course you need an order for any treatment you do.
de rn

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Jen, wound care has been a Nursing program for centuries, just make sure that you physician order to treat the wound and what type of dressing. Remember to care plan it.

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One option is to have a print shop make these for you...that is what we do. Companies that provide 15 cm wound measuring guides include Smith and Nephew and Healthpoint.

April RN CWOCN

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MAR-J Medical Supply, Inc. can provide these wound measurer’s for you. Please contact us at info@mar-jmedical.com or (888)347-7997. Thanks!

Jason

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For Terese: 3M has some nice ones with "post-it" backings. There are other companies as well. Check the Briggs and AliMed catalogs.
Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS