Article - Billing and Coding: Spiracur SNaP® Wound Care System (A53781)

CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.Article TextEffective for dates of service on and after January 1, 2013, Palmetto GBA will reimburse Smart Negative Pressure (SNaP), a process that combines a suction device with an advanced hydrocolloid wound dressing. SNaPdelivers constant and controlled levels of negative pressure to facilitate the healing of the following types of open wounds:Stage III and IV pressure ulcerNeuropathic (diabetic) ulcerChronic (present for at least 30 days) ulcer of mixed etiologyVenous or arterial insufficiency ulcerComplications of a surgically created woundTraumatic woundPalmetto GBA expects providers to utilize all accepted wound care standards prior to using SNaP.Accepted wound care standards include the following:Patient turning and positioningAppropriate surface modalities to prevent pressure woundsAppropriate management of moisture and incontinenceConsistent application of compression garments and/or bandagesLeg elevation and ambulationAppropriate topical wound treatmentsAppropriate necrotic tissue debridementNutritional status evaluation with appropriate interventionThe patient medical record maintained by the health care professional must include the following patient-specific information:Physician order for treatmentDocumentation to substantiate standard protocols have been metWound description including specific measurements and conditionPatient-specific treatment planCoding/Billing GuidelinesCMS 1500 FormAn evaluation/management (E/M) service may be billed using the appropriate E/M CPTcode appended with the 25 modifier. The E/M service may only be submitted when a separately identifiable service is performed besides the negative pressure wound therapy. If the patient's condition warrants an additional E/M service, the medical record must document the medical necessity for the E/M service including the following:Wound description including specific measurements and conditionChange in patient statusA simple check of the wound does not justify an additional E/M service and will be denied as not reasonable or necessaryCPTcode:97607 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s) wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters), or97608 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s) wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters)*NOTE: CPTCodes 97607 and 97608 are not specific to the Spiracur SNaPWound Care System. These CPT codes apply to any equivalent product. If a disposable negative pressure wound therapy (NPWT) product is used that meets the same specifications as the Spiracur SNaPWound Care System, but is a different product, the product name should be entered in the Narrative field on the CMS 1500 Form.UB-04 (CMS 1450 form) - Outpatient TreatmentTo report a SNaPtreatment in the outpatient setting, submit the following:CPTcode:97607 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s) wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters), or97608 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s) wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters)Enter 'Spiracur SNaPdevice' in the Remarks field (field locator 80) on the UB-04 (CMS 1450 form)*NOTE: CPTCodes 97607 and 97608 are not specific to the Spiracur SNaPWound Care System. These CPT codes apply to any equivalent product. If a disposable negative pressure wound therapy (NPWT) product is used that meets the same specifications as the Spiracur SNaPWound Care System, but is a different product, the product name should be entered in the Remarks field (field locator 80) on the UB-04 (CMS 1450 form).