How WISER builds audit-ready topical oxygen claims

Clean coverage rules still fail at the claim line when documentation doesn't line up with the LCD. WISER is WoundScribe's claims-and-compliance agent, built to make advanced therapy claims defensible before they leave the clinic.

Criteria mapping against LCD DL33797

WISER holds a structured version of the topical oxygen LCD — every eligibility requirement broken into discrete checks. For each candidate patient it verifies:

• Diabetes diagnosis is captured with an active ICD-10 code
• HbA1c value is present, dated, and under 12%
• Perfusion assessment is documented at the foot
• Four-week standard care trial is on record with weekly interventions
• Wound area reduction is under 50% at week four
• No exclusion diagnoses (osteomyelitis, gangrene, active infection, same-limb DVT, malignancy) are active

Code assembly

Once criteria pass, WISER assembles the claim: E0446 for the system, A4575 for the supply, physician work under 99199, and the correct DME jurisdiction. Modifiers and place-of-service are pulled from the encounter, not re-entered.

Evidence packaging for audits

Each claim carries pointers back to the source documentation — the specific note, image, and lab result satisfying each LCD element. If an ADR arrives, the packet is already assembled.

Gap alerts before submission

If a criterion is missing, WISER surfaces the gap to the clinician in-workflow, not after a denial. That closes the loop between charting and revenue cycle instead of routing rejections back through appeals.

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