Cellular and/or tissue-based products: Engineered wound dressing products created to promote biological repair or regeneration of wound tissue by providing signaling, structural, or cellular elements with or without systems that contain living tissue or cells. These products actively promote healing by stimulating the patient’s own cells to regenerate healthy tissue. There are multiple options for these products.

Compliance officer: Although the details of the role may vary regionally and institutionally, a compliance officer in health care is the professional within an organization or facility who manages adherence to relevant laws, regulation, and policies. They may develop, execute, and monitor programs to meet that goal.

Current Procedural Terminology (CPT) Codes: These codes characterize the procedure performed by a provider, and oftentimes in wound care will also indicate anatomic location and size of the wound in question. Codes such as this may be employed, for example, for debridement.

Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS): As defined by Medicare, this classification of products can include, but is not limited to: negative pressure wound therapy, wound dressings, compression therapy, support surfaces, and nutritional products. 

Evaluation and Management (E/M) Services: This type of service involves the provider using cognitive skills, along with their training, experience, and available evidence, to diagnose and treat an illness or injury. E/M services are different than procedure services. 

Healthcare Common Procedure Coding System (HCPCS): a standardized language used to describe services and medical equipment/products provided during the delivery of care. For reporting equipment and products, generic terminology identifies durable medical equipment, supplies used in conjunction with equipment and products, such as wound dressings. Drug and biologics codes are described by brand name.

International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM): These are the corresponding diagnosis codes that align with the procedure performed by the provider and any product used.

Local Coverage Article (LCA): Medicare Administrative Contractors publish these guidelines or education to complement an existing National or Local Coverage Determination, or it may also be an independent policy.  

Local Coverage Determination (LCD): Medicare Administrative Contractors (MACs) make these decisions regarding coverage of a product or service that will then apply to their specific region of jurisdiction.

Medicare Administrative Contractor (MAC): This is a regionally based Medicare insurer that processes certain claims for Medicare fee-for-service beneficiaries. MACs often have a multi-state jurisdiction and administer many aspects of the Medicare program including claim processing, provider enrollment, audit, reimbursement, establishing LCDs, and reviewing medical recording. For Medicare Parts A and B, examples of MACs are Noridian Healthcare Solutions, CGS Administrators, Novitas Solutions, and Palmetto GBA.

Modifiers: In medical coding, a modifier is 2 letters or numbers that append to another code to provide additional information about the circumstances of the service or supply without changing the meaning of the code.

Qualified health care professionals (QHP): These providers undergo and achieve training, education, licensing (when applicable), and institutional privileges (when applicable) to perform and report a service within their scope of practice.