Adding advanced wound care to a podiatry practice

Days 1 to 30: decide what you will treat and how

Define the patient population

Most podiatry wound programs start with diabetic foot ulcers and expand to venous leg ulcers, post-surgical wounds, and pressure injuries on the foot and ankle. Write down which wound types you will treat in-office, which you will co-manage, and which you will refer. This protects the program from scope creep in the first months.

Build the formulary

You do not need a large formulary. A typical starting point is one or two skin substitute options from different categories, a fish skin option, a small set of advanced dressings covering the moisture spectrum, offloading supplies, and a topical antimicrobial. Choose products for which your main payers have clear coverage, and confirm that coverage in writing before your first order.

Set up the billing pathway

Decide who will verify benefits, who will obtain prior authorizations, and who will submit claims. If your existing biller has not handled skin substitutes before, arrange training or partner with a distributor whose service includes those steps. Confirm your practice is set up correctly for in-office application billing with each payer.

Days 31 to 60: train and document

Train everyone, not just the provider

The front desk needs to know how to collect insurance information for verification. Medical assistants need to know how to measure and photograph wounds consistently. The provider and any nursing staff need product-specific application training. Schedule these as short sessions rather than one long one.

Build the note template

Your visit note should capture, at minimum: wound etiology and diagnosis codes, measurements, description of the wound bed and periwound skin, conservative care to date, vascular and glycemic status, offloading in place, the product applied with size, lot number, units, and wastage, and the plan. Build it into your EHR as a template so the same fields appear every visit. See our documentation checklist for the full list.

Set up inventory

Room-temperature products simplify storage. If you carry refrigerated products, confirm your cold-chain handling and logging. Maintain a receiving log that records lot numbers on arrival so they can be tied to patients later.

Days 61 to 90: first patients and first claims

Start with a small cohort

Choose a handful of patients with wounds that have plateaued under standard care and whose coverage has been verified. Follow the protocol exactly. This gives your team a clean set of cases to learn from.

Review the first claims closely

Before submission, check each claim against the note: procedure code matches wound size, product code and units match the product applied, diagnosis supports necessity, wastage is documented. After adjudication, review any denials and fix the upstream cause.

Measure outcomes

Track wound-area reduction over time for each patient. Most coverage policies expect evidence of response, and the data will also tell you whether your protocol is working.

Common pitfalls

• Applying a skin substitute before conservative care has been documented for the period the payer requires.
• Skipping offloading. Products do not work on a foot that is still bearing weight on the ulcer.
• Inconsistent measurement technique between staff, which makes response hard to demonstrate.
• Choosing products by rep relationship rather than by wound and coverage.
• No stop point. Decide in advance when a non-responding wound triggers a change in approach.

After 90 days

With a working protocol and a few closed wounds, expand carefully: add a product category, add a wound type, or add a second provider. Revisit coverage at least quarterly, since payer policies for skin substitutes continue to change.