The fundamental building blocks addressing prevention of skin breakdown are generally overshadowed by the deluge of intervention strategies touted for patients with chronic wounds. It’s paramount that providers take these proactive steps in clinical practice to develop sound skin care prevention and intervention pathways. To that end, the clinician must understand the anatomy and physiology of the skin, current practice guidelines, and indications and contraindications of skin care products used in clinical practice.
Use the skin care products section to help you develop a skin care formulary for your facility. When creating the skin care formulary, be sure to include products under categories such as:
Antifungals and antimicrobials (topical): products that inhibit the growth of organisms that cause superficial skin infections, such as yeast
Liquid skin protectants (also called skin sealants): products that protect the skin by forming a transparent protective barrier
Moisture barriers (also called skin protectants): ointments, creams, or pastes that protect the skin from urinary and fecal incontinence by shielding the skin from irritants or moisture (e.g., dimethicone, petrolatum, and zinc oxide).
Skin cleansers: pH-balanced products used to provide moisture and to effectively remove urine, feces, or both without patient discomfort
Therapeutic moisturizing products: lotions and creams used to replace lost lipids in skin
HCPCS code overview
Health Care Financing Administration Common Procedure Coding System (HCPCS) is a standardized coding system that is used for describing and identifying health care equipment and supplies in health care transactions not included in the current procedural terminology (CPT) codes. Because Medicare and other insurers cover a variety of services, supplies, and equipment that aren’t identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items.
The Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) is responsible for providing suppliers and manufacturers with assistance in determining which HCPCS code should be used to describe health care equipment and supplies for the purpose of billing Medicare. This standardized process to request a code for a particular supply or a request for a modification to the alphanumeric coding system for a particular product has been defined and is accessible to all suppliers and manufacturers.
You may find that many skin care products are considered routine supply items and are included in the general cost of an inpatient stay, whether the stay is for acute or long-term care. It’s the clinician’s responsibility to verify whether a product has been assigned a HCPCS code. The ultimate responsibility for correct HCPCS coding lies with the provider or supplier who is submitting a claim to a third-party payer.
ANTIFUNGALS AND ANTIMICROBIALS
The pH of the skin is in the acidic range but varies in different areas of the body. The pH is important because it regulates some of the functions of the stratum corneum, including its permeability function; the integrity and cohesion of skin cells, or what holds the cells together; and the defense against bacteria and fungi. Skin flora, or the microorganisms that live on or infect the skin, grow differently based on the skin pH. Antifungal and antimicrobial products inhibit the growth of organisms that cause superficial skin infections, such as yeast. These products are formulated as creams, ointments, lotions, or powders and may be found in select moisture barriers.
Because of the variation in coding for antifungals and antimicrobials, it’s the clinician’s responsibility to verify coding and payment of each product with the manufacturer.
Product Name
Manufacturer/Distributor
Aloe Vesta Antifungal Ointment
ConvaTec
☆Antifungal Cream
Covidien
☆Antimicrobial Cleanser
Covidien
Baza Antifungal
Coloplast Cororation
Carrington Antifungal Cream
Medline Industries, Inc.
☆DermaFungal
DermaRite Industries, LLC
☆Elta Trivase
SteadMed Medical
Micro-Guard Powder
Coloplast Corporation
Remedy Antifungal Powder & Cream
Medline Industries, Inc.
SECURA Antifungal Extra Thick
Smith & Nephew, Inc. Wound Management
SECURA Antifungal Greaseless
Smith & Nephew, Inc. Wound Management
☆3M Cavilon Antifungal Cream
3M Health Care
☆ = New Product
LIQUID SKIN PROTECTANTS
Liquid skin protectants, or skin sealants, are formulated with a polymer and solvent. When the product is applied to the skin, the solvent evaporates, and the polymer dries to form a transparent, protective barrier. Select liquid skin protectants may irritate denuded or compromised skin. The clinician should be aware that liquid skin protectants can be formulated with or without alcohol. Liquid skin protectants are manufactured in wipes, swabs, sprays, and foam applicators.
Because of the variation in coding for liquid skin protectants, it’s the clinician’s responsibility to verify coding and payment of each product with the manufacturer.
Product Name
Manufacturer/Distributor
Aloe Vesta Protective Barrier Spray
ConvaTec
Coloplast PREP
Coloplast Corp.
☆Marathon Liquid Skin Protectant
Medline Industries, Inc.
☆No-Sting Skin Prep Spray
Smith & Nephew, Inc. Wound Management
No-Sting Skin Prep Swabs
Smith & Nephew, Inc. Wound Management
No-Sting Skin Prep Wipes
Smith & Nephew, Inc. Wound Management
☆Stingfree
DermaRite Industries, LLC
Sureprep No-Sting Skin Prep Wipes
Medline Industries, Inc.
Sureprep No-Sting Spray
Medline Industries, Inc.
Sureprep No-Sting Wand
Medline Industries, Inc.
Sureprep Skin Protective Wipe
Medline Industries, Inc.
☆3M Cavilon No Sting Barrier Film
3M Health Care
☆Webcol Skin Barrier Wipe
Covidien
☆ = New Product
MOISTURE BARRIERS
Moisture barriers, sometimes called skin protectants, are ointments, creams, or pastes that shield the skin from exposure to irritants or moisture from sources such as incontinence, perspiration, and enzymatic and wound drainage. Three common ingredients found in moisture barriers include dimethicone, petrolatum, and zinc oxide or a combination thereof. Some products are formulated with additional properties such as antibacterial, antiyeast, or antifungal ingredients. A moisture barrier may be formulated with a skin cleanser or as a stand-alone paste, cream, powder, or ointment. Once the moisture barrier is applied to the skin, it may appear clear, translucent, or opaque depending on the formulation.
Because of the variation in coding for moisture barriers, it’s the clinician’s responsibility to verify coding and payment of each product with the manufacturer.
Product Name
Manufacturer/Distributor
Aloe Vesta Protective Barrier Spray
ConvaTec
Aloe Vesta Protective Ointment
ConvaTec
Amerigel Barrier Lotion
Amerx Health Care Corporation
CalmoDerm
DermaRite Industries, LLC
Carrington Moisture Barrier Cream and Moisture Barrier with Zinc
