TCC is the gold standard for wound care and acute Charcot arthropathy. However, the cost of the casting materials and the time required vs. reimbursement makes it not feasible for the office setting. This is where the referral to a wound care center becomes necessary.
I disagree with Dan. With the kits that are now available, including a "roll on" knitted fiberglass cast, the cost is kept to reasonable levels and the time required to apply a cast requires only 8-10 minutes of the clinician's time.
I suppose reimbursement may be based on your location. I am in Colorado and have no difficulty with reimbursement and perform between 2-10 TCCs daily. I am in a private practice office. Reimbursement is quite good.
In our office, the answer is yes and no. Yes, I have used it with success in the past and would not hesitate to use it again in the future.
However, with that said, I have not had to use this form of care in the past 10 years or more as boot casts, CROW boots, orthobiologics, crutches and wheelchairs providing NWB have been extremely effective and more convenient for the patients and the practice. The wounds close just as quickly and even more so with the added benefit of access to the wound for.your skin substitutes and ability to monitor them closer.
There are cost and time concerns but it is often a very useful modality. That's why I utilize it on my wound center days as the well trained staff makes it much more feasible to do.
We have never had a problem with reimbursement in Florida.
Time is certainly a consideration. One way we solved this issue was by scheduling TCC patients in the same time block (if possible) and separated from the other patients.
The more you practice this important modality, the more proficient you will become. The value of using TCC for our patients has been invaluable.
Lastly, from removal of a previously applied TCC, debridement and application of a new TCC, we average about 45 minutes. We do not use the pre-packaged kits. We have found the TCC to be a very important modality in the comprehensive wound care "toolbox".
If you are not comfortable in TCC application, please either learn how to apply it or refer to someone who is confident in using this very important adjunctive therapy.
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