Emerging Insights On Negative Pressure Wound Therapy

Author(s): 
Karen Shum, DPM, and Kazu Suzuki, DPM, CWS

   This CPT code was introduced in 2005. It allows the clinicians to bill for the time, technical knowledge and the expertise to apply a “powered” NPWT device, such as VAC therapy. Clinicians may use this code in the office as it does not apply to OR applications of NPWT. For the total wound surface area over 50 cm2, use CPT 97606 in place of CPT 97605 (Work RVU 0.6, Non-facility RVU 0.63).

G0456 (HCPCS code)
Descriptor: Negative pressure wound therapy, using a disposable mechanically powered device, including topical application, wound assessment and instructions for ongoing care, per session. Total wound surface area less than or equal to 50 cm2. For the wound size over 50 cm2, G0457 should be used.

   Introduced in 2013, this G code (G0456) is a new Healthcare Common Procedure Coding System (HCPCS) code for billing Medicare for supplies and material, specific to the use of the SNaP system. This G code (G0456) represents both product and service components combined into one therapy code. It is a “significant procedure” and multiple procedure reduction applies. Physicians, facilities or both may bill this code based upon the types of service being administered as well as the care site in which one delivers care.

   As this article goes to press, the product side of the code has already been assigned to a payment rate in the Outpatient Prospective Payment System fee schedule (the hospital outpatient Ambulatory Payment Classification value) as $209.65 and the physician’s service component (RVUs) in the outpatient hospital facility is “to be determined” by the local medical carrier upon review of documentation. Currently, there are no National Correct Coding Initiative edits established by CMS to determine what one can or cannot bill simultaneously. The physician would determine this on a case-by-case basis upon claim submission.19

In Conclusion

Negative pressure wound therapy is a safe, versatile and clinically proven modality, which reduces wound closure time, and has recently enjoyed new portability and irrigation functionality with the introduction of the SNaP and VAC Ulta devices. The increased use of NPWT will overall reduce medical care costs and provide better patient outcomes in the care of diabetic foot ulcers.

   Dr. Shum is a third-year resident with the Cedars Sinai Medical Center Podiatric Medicine and Surgery Residency Program in Los Angeles.

   Dr. Suzuki is the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo. He can be reached via email at Kazu.Suzuki@CSHS.org .

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