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) |
Particles (ml) |
Particles
(grams) |
|
Surface Area (sq cm) |
Particles (ml) |
Particles
(grams) |
| 1 |
0.25 |
0.025 |
|
20 |
5.00 |
0.500 |
| 2 |
0.50 |
0.050 |
|
21 - 25 |
6.25 |
0.625 |
| 3 |
0.75 |
0.075 |
|
26 - 30 |
7.50 |
0.750 |
| 4 |
1.00 |
0.100 |
|
31 - 35 |
8.75 |
0.875 |
| 5 |
1.25 |
0.125 |
|
36 - 40 |
10.00 |
1.000 |
| 6 |
1.50 |
0.150 |
|
41 - 45 |
11.25 |
1.125 |
| 7 |
1.75 |
0.175 |
|
46 - 50 |
12.50 |
1.250 |
| 8 |
2.00 |
0.200 |
|
51 - 60 |
15.00 |
1.500 |
| 9 |
2.25 |
0.225 |
|
61 - 70 |
17.50 |
1.750 |
| 10 |
2.50 |
0.250 |
|
71 - 80 |
20.00 |
2.000 |
| 12 |
3.00 |
0.300 |
|
81 - 90 |
22.50 |
2.250 |
| 14 |
3.50 |
0.350 |
|
91 - 100 |
25.00 |
2.500 |
| 16 |
4.00 |
0.400 |
|
101 - 110 |
27.50 |
2.750 |
| 18 |
4.50 |
0.450 |
|
111 - 120 |
30.00 |
3.000 |
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 0.3 gm per change (from above table for 12 sq cm surface area) = 4.5 gm or 5 gm (round to the next whole number)
This is the amount to be billed to Medicare/Medicaid.
Step 4: Product to patient.
Product = Total amount in grams (from Step 3) / grams per vial
= total number of vials to patient.
In this example the most cost-effective solution is MF 1020:
| Product |
Quantity (gm) |
Total number of vials |
| MF 1005 (2.5 ml = 0.25 gm) |
= ________ |
= __________ (round to a whole number) |
| MF 1010 (5.0 ml = 0.50 gm) |
= ________ |
= __________ (round to a whole number) |
| MF 1020 (10.0 ml = 1.00 gm) |
= ____5___ |
= ____5_____ (round to a whole number) |
| MF 1030 (15.0 ml = 1.50 gm) |
= ________ |
= __________ (round to a whole number) |
Medicare has approved Medifil® Particles for moderately to heavily draining wounds, at least 0.5 cm in depth. |
