(CR-048) When Numbers Don't Add Up: How Inconsistent Wound Measurements Compromise Reimbursement and Negative Pressure Wound Therapy Eligibility

Friday, April 10, 2026

Rebecca Helms, PT, DPT, WCC – Assistant Professor and Director of Clinical Education, DPT, Methodist University; Nicole Hodges, PT, DPT, PhD, ATC – Assistant Professor, DPT, Methodist University

Introduction: Accurate wound measurements are essential for clinical documentation (1) directly influencing reimbursement, patient eligibility, and continuation of Negative Pressure Wound Therapy (NPWT). Inconsistent wound measurement documentation presents challenges in meeting payer requirements, as NPWT eligibility depends on documented wound progression measurements over time. Perceived lack of wound improvement due to inconsistent measurements may result in insurance coverage denial or premature discontinuation of therapy (2).

Methods: Researchers conducted a convenience sample of wound care providers (n=94). Participants completed a content-validated anonymous survey via Qualtrics. Survey content included assessment of inter-rater reliability measuring length and width on four standardized two-dimensional wound images and experience with reimbursement and denials of services, including NPWT. Participants selected their preferred method for measuring and applied that technique to each image. Analyses were completed using Excel and Jamovi (3). Agreement between selected and applied techniques was evaluated using Cohen’s kappa and McNemar’s test, while true inter-rater reliability was assessed using Krippendorff’s alpha.

Results:

A total of 94 participants responded, including nurses (70%), physical therapists (23%), occupational therapists (3%), and physicians (1%), with an average of 14 years of wound care experience. Three measurement techniques were identified: Box Method (4), clock-face method, and longest length/widest width method (5). Although 78% of respondents believed wound measurement standardization was achievable, agreement between selected and applied techniques was poor (κ = 0.00–0.16), with random variability in technique use (McNemar’s p = 1.00).

Ninety percent of participants reported that inconsistent wound measurements negatively impacted reimbursement. Twenty-six percent reported experiencing reimbursement denial, while 71% were unsure whether their reimbursement had been affected. Clinicians with advanced certifications reported greater recognition of the importance of accurate wound measurements, its impact on reimbursement (U = 681, p = .001) and denial of services, including NPWT (U = 724, p = .003).

Discussion: Despite strong awareness of the importance of wound measurement accuracy, clinicians frequently applied different techniques when evaluating identical wounds. These findings highlight the need for a standardized method of measuring wounds, training, and implementation strategies to improve measurement consistency in order to protect reimbursement and support continued patient access to NPWT.