FAQ'S
Should the wounds Cascade is used on be debrided?
Yes! Debridement is critical in ensuring healthy tissue, with proper vascularization, grows into the wound.
Should Cascade be used in conjunction with the standard of care?
Yes! Use Cascade in conjunction with standard of care for the type of wound Cascade is being used to treat.
This includes, but is not limited to
Offloading for DFUs
Compression for VLUs
Debridement
Infection control
Monitoring wound volume changes
Referrals to specialists, eg, a vascular specialist
Are there any conditions or diseases in which Cascade is contraindicated?
Cascade is contraindicated for use with presence of a tumor, metastatic disease, active infection, thrombocytopenia (platelet count below 150,000 platelets per microliter), or pregnancy.
Source(s)
Bava ED, Barber FA. Platelet-Rich Plasma Products in Sports Medicine. The Physician in Sports Medicine, Vol. 39, Issue 3. Sept. 2011
Cited in “Cascade Introduction – 1_20_17 v 8-25-22-New” powerpoint
Top right column under Table 2, on page 96
Alternative answer:
See the IFU within the Cascade kit for more information on contraindications.
What stops blood from coagulating in Cascade?
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Is anticoagulant sodium citrate or ACD-A? I have resources that say both?
Do “blood thinning" medications affect the coagulation time of Cascade PRFM?
How large is the PRFM produced by Cascade?
The size of Cascade PRFM is determined by the dimensions of the bottle in which it is formed. The Cascade PRFM has a 33 millimeter diameter and an area of 8.5 cm2. For reference, a quarter has a diameter of 24 millimeters and an area of 4.5 cm2.
Is Cascade PRFM easy for a health care provider to handle and apply to a wound?
Cascade PRFM can be easily handled with forceps.
Cascade PRFM has been found to have an average elastic modulus of 937 kPa. That level of mechanical strength is comparable to arterial tissue, which represents approximately 50% of the stiffness of intact human skin.
How is the fibrin catalyzed to PRFM without exogenous thrombin?
The Cascade Autologous Platelet System uses the body’s own (endogenous) thrombin and calcium chloride, in the green PRFM bottle, to catalyze the conversion of fibrinogen into the fibrin in the PRFM.
What dressings and bandages should be used with Cascade?
Dressing and bandages of the health care provider’s choice (following guidelines for the type of wound to which they are applied) can be used with Cascade.
The primary bandage should not be removed between weekly visits to the health care provider responsible for wound care.
The primary bandage should not be covered with tape. Covering the primary bandage with tape will prevent the drainage of wound exudate to the secondary bandage.
The secondary bandage should be chosen to optimize the removal of wound exudate while maintaining a moist wound environment. If the secondary bandage is overly saturated, it is recommended to use a more absorbent type of bandage. Monitor the secondary bandage and make changes accordingly.
What level of platelet concentration is considered sufficient for PRP to be effective?
Platelets in whole blood are typically found at concentrations of 1.5-4.5×105 platelets per microliter of whole blood.
PRP is generally considered to be effective at a concentration 4-5x above baseline whole blood.
Need to double check source(s) on this
How to place Cascade on a wound?
Place Cascade PRFM in contact with the edge of the wound to ensure enablement of the Edge Effect – that epithelialization of a wound occurs at the edge where it interfaces with healthier skin. Additional PRFM should be in contact with the wound bed.
After the 2nd centrifugation that forms PRFM, the force of the centrifugation concentrates platelets at the bottom of the membrane. It is likely best practice to place the bottom of the PRFM in contact with the wound bed.
Other suggestions include:
The mechanical strength of Cascade PRFM is comparable to arterial tissue, which represents approximately 50% of the stiffness of intact human skin. Cascade can be sutured into a wound’s edges if a health care provider believes this is necessary.
The membrane can be defenestrated to facilitate the release of wound exudate to bandaging and gas exchange. Prior clinical work has used uniform 3 mm slits. Extensive defenestration of the membrane can theoretically lower the mechanical strength of the PRFM.
Does how long a wound is open matter?
Yes. The duration that a wound remains unclosed can increase risk of infection, lower extremity amputation, and other complications.
Does the quality of healed tissue matter?
Yes, the quality of the healed tissue can affect the risk of recurrence and functionality of the healed tissue. Well organized collagen and vascularization are important factors in the quality of healed tissue.
What factors determine if Cascade will be effective?
Factors that determine if Cascade will be effective include, but are not limited to, adequate vascular perfusion and HbA1c level.
Reimbursement?
I would not include this question or answers. I am providing it as it is my best understanding of what reimbursement looks like for PRP and wounds for anyone at PRPC who is curious. As such, information is not fully organized into an answer for the website.
This information on coding, Medicare payment, and coverage is provided as a courtesy to Health Care Providers, but it does not constitute a guarantee or warranty that payment will be received.
Coding and Medicare payment information changes. We strongly recommend that all Health Care Providers print and read guidelines for themselves. Wound/ulcer management professionals should obtain (from the correct payer) current coding, payment system, coverage policies, and regulations
Be sure to fully document a patient’s medical record, medical necessity, referrals (eg Referral to a vascular specialist) to demonstrate everything is being done to ensure proper treatment
Documentation of treatment needs to cover: what happened since last week/treatment, this is what I will do this week, the expectation
Additionally, CMS LCD requires specific standard of care treatment (eg debridement, offloading, compression…) be used for 4 weeks before considering application and requesting reimbursement for advanced therapies in chronic wounds.
50% decrease or greater in wound area at 4 weeks = SOC is sufficient
Met? Continue with SOC treatment
Not met? Consider advanced therapy
Code G0465- DFU National Coverage Decision so CMS will cover
Get exact language from CMS website NCD 270.3 (?)
National average payment around $1650. Need to double check with source
Code G0460- for other chronic wounds. At Medicare Contract Administrator’s discretion.
DOCUMENTATION requirements/guidelines?
4 weeks of conservative care
Medical necessity
Comorbidity management
Wound tracking- progression/decline
Patient compliance
Patient education
Vascular testing
KX modifier indicates additional applications is medically necessary and fully documented, and that the care is compliant with all of the LCD and LCA requirements
