Step 1: Calculate surface area of the wound.
| Shape of Wound |
Dimensions of Wound (cm) |
Surface area of Wound (cm) |
Rectangular
(example) |
Length: 3 cm ________
Width: 4 cm ________ |
Surface Area: Length x Width
Surface Area = 3 x 4 = 12 sq cm
________ sq cm |
| Circular |
Diameter: ________ cm |
Surface Area: .785 x diameter x diameter
Surface Area: _____________ sq cm |
Step 2: Determine amount of particles for the surface area calculated above using the chart below:
| Surface Area (sq cm) |
Gel (cc) |
Gel (oz) |
|
Surface Area (sq cm) |
Gel (cc) |
Gel (oz) |
| 1 |
0.25 |
0.01 |
|
20 |
6.0 |
0.21 |
| 2 |
0.60 |
0.02 |
|
21 - 25 |
7.5 |
0.26 |
| 3 |
0.90 |
0.03 |
|
26 - 30 |
9.0 |
0.32 |
| 4 |
1.20 |
0.04 |
|
31 - 35 |
10.5 |
0.37 |
| 5 |
1.50 |
0.05 |
|
36 - 40 |
12.0 |
0.42 |
| 6 |
1.80 |
0.06 |
|
41 - 45 |
13.5 |
0.48 |
| 7 |
2.10 |
0.07 |
|
46 - 50 |
15.0 |
0.53 |
| 8 |
2.40 |
0.08 |
|
51 - 60 |
18.0 |
0.64 |
| 9 |
2.70 |
0.10 |
|
61 - 70 |
21.0 |
0.74 |
| 10 |
3.00 |
0.11 |
|
71 - 80 |
24.0 |
0.85 |
| 12 |
3.60 |
0.13 |
|
81 - 90 |
27.0 |
0.95 |
| 14 |
4.20 |
0.15 |
|
91 - 100 |
30.0 |
1.06 |
| 16 |
4.80 |
0.17 |
|
101 - 110 |
33.0 |
1.16 |
| 18 |
5.40 |
0.19 |
|
111 - 120 |
36.0 |
1.27 |
Step 3: Product usage for billing.
Usage = Number of dressing changes x amount per dressing change
Usage = ______________ x _____________ = ________
For example if 15 dressing changes are prescribed then,
Usage = 15 dressing changes x 0.13 oz per change (from above table for 12 sq cm surface area) = 1.95 oz or 2 oz (round to the next whole number)
This is the amount to be billed to Medicare/Medicaid.
Step 4: Product to patient.
30 cc = 1 oz.
Product = Total amount in ounces (from Step 3) x 30 / cc per syringe
= total number of syringes to patient.
Example = 2 oz x 30 / 9 = 6.7 syringes or 7 syringes (rounding to the next whole number).
In this example the most cost-effective solution is MFG 1050:
| Product |
Quantity (oz) |
Total number of syringes |
| MFG 1040 (3 cc syringe = 0.1 ounce) |
= _____ |
= __________ (round to a whole number) |
| MFG 1050 (9 cc syringe = 0.3 ounce) |
= __2__ |
= ____7_____ (round to a whole number) |
Medicare has approved Medifil® Gel for dry to minimally draining wounds, at least 0.5 cm in depth. |
