March 5, 2013
Re: Olivia Swan
Age: 75 years old
Policy number# 12345678
To: Linda M. Schultz, Director of Medical Requests
The Life Insurance Company
I am writing to request authorization for payment for a KCI Wound Vacuum Assisted Closure System and dressing supplies for Olivia Swan. Olivia is 75 years old, single and lives independently in her own home. Olivia has Type II diabetes and hypertension and she had a colectomy for an intestinal obstruction 2/14/2012 with a complication of a wound dehiscence at the bottom of her abdominal incision five days post op. She now has an open area at the bottom of her abdominal incision just above the pubis that is 3cm X 3cm and 5cm deep. The area is compromised by her pendulous abdomen which makes it impractical for her to clean and dress the wound with a wet to dry dressing BID. She cannot elevate her abdomen skin tissue and perform the dressing change at the same time. She does have a home health nurse who monitors her condition three times a week. The KCI wound vacuum closure system and dressing supplies is medically necessary. Effective wound management is critical to positive patient outcomes. Because Olivia wound area is compromised and she cannot elevate her abdomen skin tissue which makes it impractical for her to perform her wet to dry dressing change BID. The wound vacuum closure system was found to be most appropriate for Olivia considering her past medical history of Type II diabetes and her inability to perform her own dressing changes. The wound V.A.C system promotes wound healing by reducing edema allowing tissue decompression it removes exudate and infectious materials, applies controlled, localized negative pressure to help uniformly draws wound closed, promotes, granulation tissue formation and perfusion, provides a closed, moist wound healing environment, and prepares wound bed for closure. The wound vacuum closure system and dressings will reasonably prevent the onset of...
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