Wound Product Selection Guide*

Adapted from ConvaTecs evidence-based Solutions Algorithms1,

which have been content-, construct- and face-validated 24

Step 1:

Step 2:

Step 3:

Step 4:

Assess the wound based

on wound characteristics:
wound depth (or necrotic
tissue) and exudate level

Measure
the wound
with the
ConvaTec
wound
measuring
guide

Debride if
greater
than 25%
necrotic
tissue**

Full Thickness

Cleanse the
wound with
SAF-Clens
AF wound
cleanser

Superficial or Partial Thickness

Wound Depth / Exudate Level

ConvaTec

Solutions

Programs

Choose the appropriate Primary and

Secondary dressings from the chart below

Step 5:

Primary Dressing

Secondary Dressing

(Fill/Dress)

(Cover)

Minimal
Moisture

DuoDERM Extra Thin

OR DuoDERM Signal

None needed

Lightly
Exudating

Versiva XC
OR DuoDERM Signal

None needed

Moderately
Exudating

Versiva XC
OR CombiDERM
OR AQUACEL
OR AQUACEL Ag

Versiva XC
DuoDERM Signal
OR CombiDERM

OR CarboFlex

Heavily
Exudating

AQUACEL
OR AQUACEL Ag

OR

Minimal
Moisture

SAF-Gel OR DuoDERM
Hydroactive Gel OR
Premoistened AQUACEL OR
Premoistened AQUACEL Ag

DuoDERM Extra Thin

OR DuoDERM Signal

Lightly
Exudating

SAF-Gel OR DuoDERM
Hydroactive Gel OR
Premoistened AQUACEL OR
Premoistened AQUACEL Ag
OR Versiva XC

Versiva XC
OR DuoDERM Signal
OR CombiDERM

OR CarboFlex

Moderately
Exudating

AQUACEL
OR AQUACEL Ag
OR Versiva XC
OR CombiDERM

Versiva XC
OR DuoDERM Signal
OR CombiDERM

OR CarboFlex

Heavily
Exudating

AQUACEL
OR AQUACEL Ag

Versiva XC
OR CombiDERM

OR CarboFlex

OR

Versiva XC
CombiDERM

OR CarboFlex

* Chart is intended as a general guide to product use; wound management decisions must be based on the clinical judgement of the attending healthcare professional. See product package inserts for complete instructions for use.
** Do not debride dry necrotic wounds on the feet unless under the supervision of a healthcare professional.

Use AQUACEL dressings for noninfected wounds and AQUACEL Ag dressings for infected wounds or wounds at risk for infection.

Apply compression as appropriateSurePress and Unna-Flex systems.

For malodorous woundsCarboFLEX or AQUACEL Ag.

2010 ConvaTec Inc. / indicates trademarks of ConvaTec Inc.

Printed in U.S.A.

AP-00XXXX-US

A wide range of advanced wound care dressings that allows you to manage delicate wounds
Skin Care Management
Aloe Vesta Body Wash & Shampoo
Order Code

Size

# of Units

HCPCS Code Facility Order #

324604

4 oz.

48 bottles per case

324609

8 oz.

48 bottles per case

324612

1 ltr. bottle

8 bottles per case

4 ltr.

Other Moisture Retentive Dressings (continued)

Other Exudate Management Dressings

Flexi-Seal FMS

DuoDERM CGF Border Dressing

CombiDERM non-adhesive dressings

Order Code

# of Units

HCPCS Code

411100

1 kit per box, 3 bags

Flexi-Seal FMS Collection Bags

4 bottles per case

Order Code

# of Units

Charcoal Filter

411102

10 per box

Yes

411101

10 per box

No

Aloe Vesta Cleansing Foam

Order Code

Size

# of Units

325208

8 oz.

12 bottles per case

325204

4 oz.

24 bottles per case

Facility Order #

HCPCS Code

Facility Order #

# of Units

HCPCS Code

# of Units

650078

10 per box

A4330

HCPCS Code Facility Order #

SAF-Clens AF Dermal Wound Cleanser

Order Code

Sensi-Care Septi-Soft Concentrate

Order Code

Size

# of Units

325304

4 oz.

48 bottles per case

325309

8 oz.

48 bottles per case

HCPCS Code Facility Order #

159712

Size

# of Units

HCPCS Code

Size

# of Units

324704

4 oz.

48 bottles per case

12 oz

6 per box

A6260

324709

8 oz.

48 bottles per case

HCPCS Code Facility Order #

Order Code

Size

# of Units

HCPCS Code

145730

3 oz.

12 per case

A6248

Facility Order #

DuoDERM Hydroactive Gel

Size

# of Units

324504

4 oz.

48 bottles per case

324509

8 oz.

48 bottles per case

HCPCS Code Facility Order #

Order Code

Size

# of Units

HCPCS Code

187987

30 g

3 per box

A6248

187990

15 g

10 per box

A6248

Facility Order #

Size

# of Units

324802

2 oz.

98 bottles per case

324804

4 oz.

48 bottles per case

HCPCS Code

Facility Order #

DuoDERM Signal Sterile Dressing

48 bottles per case

Order Code

Size

# of Units

324403

3 oz.

24 tubes per case

HCPCS Code Facility Order #

Aloe Vesta Protective Barrier Spray

Size

# of Units

HCPCS Code

2.1 oz.

24 bottles per case

Facility Order #

Aloe Vesta Protective Ointment

Order Code

Size

Shape

# of Units HCPCS Code Facility Order #

403326

4" x 4"

Square

5 per box

A6237

5.5" x 5.5" Square

5 per box

A6238

403327
403328

8" x 8"

Square

5 per box

A6238

403332

6" x 7"

Triangle

5 per box

A6238

403333

8" x 9"

Triangle

5 per box

A6238

410500

7.5" x 7.8"

Heel

5 per box

A6235

410501

8" x 9"

Sacral

5 per box

A6236

4.5" x 7.5"

Oval

5 per box

A6235

410510

# of Units

HCPCS Code

324913

2 oz.

24 tubes per case

324908

8 oz.

12 tubes per case

Size

# of Units

4 oz.

24 tubes per case

Size

# of Units

325102

2 oz.

12 tubes per case

325105

5 oz.

12 tubes per case

Order Code

Facility Order #

HCPCS Code Facility Order #

Size

Shape

Fecal Incontinence Solutions

Flexi-Seal SIGNAL FMS
1 kit per box, 3 bags

HCPCS Code

Facility Order #

Flexi-Seal FMS Advanced Odor Control

Order Code

# of Units

411104

1 kit per box, 3 bags

Square

10 per box

187971

4" x 4"

5 per box

A6234

187774

3" x 3"

Square

10 per box

A6234

187972

6" x 6"

5 per box

A6235

187775

6" x 10"

Rectangular 5 per box

A6236

187973

4" x 5"

5 per box

A6235

187974

6 x 7

5 per box

A6238

HCPCS Code

Facility Order #

Order Code

187900

2" x 4" Rectangle 20 per box

A6234

187901

3" x 3"

Square

20 per box

A6234

187902

4" x 6"

Oval

10 per box

A6235

187903

6" x 7"

Triangle

10 per box

A6235

187932 1.75" x 1.5" Spot

20 per box

A6234

187955

4" x 4"

Square

10 per box

A6234

187957

6" x 6"

Square

10 per box

A6235

187961

2" x 8" Rectangle 10 per box

A6234

A6235

CombiDERM ACD (adhesive cover dressing) dressings

Size

Shape

# of Units HCPCS Code Facility Order #

187725 5.25" x 5.25" Square

10 per box

A6237

401848

8" x 8"

Square

5 per box

A6238

401849

8" x 9"

Triangle

5 per box

A6238

651027

6" x 7"

Triangle

5 per box

A6238

CarboFlex odor control dressings

651029

6" x 10" Rectangular 5 per box

A6238

Order Code

651031

4" x 4"

A6237

Specialty primary dressings

Size

Shape

403202

4" x 4"

Square

10 per box

A6196

403203

3" x 6" Rectangle 5 per box

A6197

403204

6" x 8" Rectangle 5 per box

A6197

# of Units HCPCS Code Facility Order #

Square

10 per box

Compression products

# of Units HCPCS Code Facility Order #

Order Code

# of Units

HCPCS Code

650944

12 per case

A6456/A6454

Facility Order #

Each convenience
pack contains:

(1) 4" x 10 yds. UNNA-FLEX elastic bootA6456

(1) 4" x 5 yds. self-adherent bandage A6454
12 convenience packs per casetypically sold only in case quantities

Size

Shape

177901

2" x 2"

Square

10 per box

A6196

177902

4" x 4"

Square

10 per box

A6196

177903

6" x 6"

Square

5 per box

A6197

CAUTION: This product contains natural rubber latex which may cause
allergic reactions.

403770 .75" x 18" Ribbon w/ 5 per box

Strengthening
Fiber

A6199

UNNA-FLEX elastic Unnas Boot

AQUACEL Ag Hydrofiber Dressing with Ionic Silver

# of Units HCPCS Code Facility Order #

Order Code

Size

# of Units

HCPCS Code

650940

3" x 10 yds.

12 per box

A6452

650941

4" x 10 yds.

12 per box

A6452

Order Code

Size

# of Units

HCPCS Code

650947

4" x 3.2 yds.

1 per box

A6452

Size

Shape

403706

2" x 2"

Square

403765

4" x 4.7"

403710

6" x 6"

Square

5 per box

A6197

403711

8" x 12"

Rectangle

5 per box

A6198

Order Code

Size

# of Units

HCPCS Code

403771 .75" x 18" Ribbon w/ 5 per box

Strengthening
Fiber

A6199

650948

4" x 3.2 yds.

6 per box

A6441

10 per box

A6196

Rectangle 10 per box

A6197

412009

Size

For Incisions up to

# of Units

3.5" x 4"

1.5"

10 per box

412010

3.5" x 6"

3.5"

10 per box

412011

3.5" x 10"

6.5"

5 per box

412012

3.5" x 14"

10.5"

5 per box

Order Code

Size

Shape

410606

Square

10 per box

A6209

410607 4.25" x 4.25" Square

3" x 3"

10 per box

A6209

410608

6" x 6"

Square

5 per box

A6210

410614

8" x 8"

Square

5 per box

A6211

Order Code

Size

# of Units

HCPCS Code

187660

4" x 4"

5 per box

A6234

187658

4" x 4"

20 per box

A6234

410609

4" x 4"

Square

10 per box

A6212

187661

6" x 6"

5 per box

A6235

410610

5.5" x 5.5"

Square

10 per box

A6212

187659

6" x 6"

20 per box

A6235

410612

7.3" x 8.1"

Heel

5 per box

A6213

187643

6" x 8"

5 per box

A6235

410613

9.8 x 8.3

Sacral

5 per box

A6213

187662

8" x 8"

5 per box

A6236

410615

7.5 x 7.5

Square

5 per box

A6213

187644

8" x 12"

5 per box

A6236

Adhesive

Facility Order #

SurePress absorbent padding

Facility Order #

# of Units HCPCS Code Facility Order #

Non-Adhesive

Facility Order #

SurePress high compression bandage

Order Code

Versiva XC Gelling Foam Dressing

Facility Order #

UNNA-FLEX PLUS venous ulcer convenience pack

Order Code

Order Code

# of Units HCPCS Code Facility Order #

DuoDERM CGF Dressing

418000

5.25" x 5.25"

AQUACEL Ag SURGICAL Dressings with Ionic Silver

DuoDERM Extra Thin Sterile Dressing

HCPCS Code

Order Code

# of Units

187773

420128 .39" x 18" Ribbon w/ 5 per box

Strengthening
Fiber

Aloe Vesta Antifungal Ointment

Order Code

A6234

Facility Order #

Sensi-Case Protective Barrier

325614

Moisture-retentive dressings

Sensi-Care Moisturizing Body Cream

Order Code

# of Units HCPCS Code Facility Order #

5 per box

420127 .39" x 18" Ribbon w/ 5 per box

Strengthening
Fiber

Aloe Vesta Skin Conditioner

Order Code Size

Shape

2.5" x 2.5"

Hydrofiber Dressings

SAF-Gel Hydrating Dermal Wound Dressing Gel With Alginate

Order Code

413401

Size

187970

Exudate management dressings

Wound hydration

Sensi-Care Perineal/Skin Cleanser

Order Code

Facility Order #

AQUACEL Hydrofiber Wound Dressing

Order Code

8 oz.

HCPCS Code

Facility Order #

Aloe Vesta Perineal/Skin Cleanser

324809

# of Units

Facility Order #

Wound cleansers

325521 8 towelettes 24 packs per case

per pack

Order Code

Size

Order Code

Order Code

Aloe Vesta Bathing Cloths

Size

HCPCS Code

Order Code

Flexi-Seal Fecal Collector

Order Code

Facility Order #

122101 1 ltr. dispenser 4 dispensers per case

324611

Other Fecal Incontinence Solutions (continued)

Facility Order #

References: 1. SOLUTIONS wound care algorithm. National Guideline Clearinghouse.

U.S. Department of Health and Human Services, Agency for Healthcare Research and
Quality. http://www.guideline.gov. Accessed August 17, 2010. 2. Beitz JM, van Rijswijk
L. Using wound care algorithms: a content validation study. J WOCN. 1999
Sep;26(5):238-249. 3. Bolton L, McNees P, van Rijswijk L, et al. Wound-healing
outcomes using standardized assessment and care in clinical practice. J WOCN. 2004
Mar/Apr;31(2):65-71. 4. Beitz JM, van Rijswijk L. A cross-sectional study to validate
wound care algorithms for use by registered nurses. Ostomy Wound Manage.
2010;56(4):46-59.

The reimbursement information provided by

ConvaTec is intended to provide general
information only. Coverage and payment policies
for the same insurer such as Medicare can vary
from one region to another and may change from
time to time because of ongoing changes in
government and insurance industry rules and
regulations. Please check Medicares and
Medicare contractrors (DME MAC) websites or
other provider communications for any updates,
to confirm the use of appropriate HCPCS Codes
and to verify that billing is consistent with the
particular insurer's requirements. Since patient
conditions and insurer requirements vary widely,
ConvaTec cannot guarantee coverage or payment
of its products.