Local Coverage Article Billing and Coding

Billing and Coding: Spiracur SNaP® Wound Care System

A53781

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Contractor Information

Article Information

General Information

Article ID
A53781
Article Title
Billing and Coding: Spiracur SNaP® Wound Care System
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
01/01/2020
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

Effective 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. SNaP® delivers constant and controlled levels of negative pressure to facilitate the healing of the following types of open wounds:

•Stage III and IV pressure ulcer

•Neuropathic (diabetic) ulcer

•Chronic (present for at least 30 days) ulcer of mixed etiology

•Venous or arterial insufficiency ulcer

•Complications of a surgically created wound

•Traumatic wound

Palmetto GBA expects providers to utilize all accepted wound care standards prior to using SNaP®.

Accepted wound care standards include the following:

•Patient turning and positioning

•Appropriate surface modalities to prevent pressure wounds

•Appropriate management of moisture and incontinence

•Consistent application of compression garments and/or bandages

•Leg elevation and ambulation

•Appropriate topical wound treatments

•Appropriate necrotic tissue debridement

•Nutritional status evaluation with appropriate intervention

The patient medical record maintained by the health care professional must include the following patient-specific information:

•Physician order for treatment

•Documentation to substantiate standard protocols have been met

•Wound description including specific measurements and condition

•Patient-specific treatment plan

Coding/Billing Guidelines

CMS 1500 Form
An evaluation/management (E/M) service may be billed using the appropriate E/M CPT® code 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 condition

•Change in patient status

•A simple check of the wound does not justify an additional E/M service and will be denied as not reasonable or necessary

•CPT® code:
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), or


97608 (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: CPT® Codes 97607 and 97608 are not specific to the Spiracur SNaP® Wound 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 SNaP® Wound 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 Treatment
To report a SNaP® treatment in the outpatient setting, submit the following:

•CPT® code:
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), or


97608 (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 SNaP® device' in the Remarks field (field locator 80) on the UB-04 (CMS 1450 form)

*NOTE: CPT® Codes 97607 and 97608 are not specific to the Spiracur SNaP® Wound 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 SNaP® Wound 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).

Coding Information

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
97607 NEGATIVE PRESSURE WOUND THERAPY, (EG, 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
97608 NEGATIVE PRESSURE WOUND THERAPY, (EG, 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

CPT/HCPCS Modifiers

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
25 SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE: THE PHYSICIAN MAY NEED TO INDICATE THAT ON THE DAY A PROCEDURE OR SERVICE IDENTIFIED BY A CPTCODE WAS PERFORMED, THE PATIENT'S CONDITION REQUIRED A SIGNIFICANT, SEPARATELY IDENTIFIABLE E/M SERVICE ABOVE AND BEYOND THE OTHER SERVICE PROVIDED OR BEYOND THE USUAL PREOPERATIVE AND POSTOPERATIVE CARE ASSOCIATED WITH THE PROCEDURE THAT WAS PERFORMED. THE E/M SERVICE MAY BE PROMPTED BY THE SYMPTOM OR CONDITION FOR WHICH THE PROCEDURE AND/OR SERVICE WAS PROVIDED. AS SUCH, DIFFERENT DIAGNOSES ARE NOT REQUIRED FOR REPORTING OF THE E/M SERVICES ON THE SAME DATE. THIS CIRCUMSTANCE MAY BE REPORTED BY ADDING THE MODIFIER -25 TO THE APPROPRIATE LEVEL OF E/M SERVICE, OR THE SEPARATE FIVE DIGIT MODIFIER 09925 MAY BE USED. NOTE: THIS MODIFIER IS NOT USED TO REPORT AN E/M SERVICE THAT RESULTED IN A DECISION TO PERFORM SURGERY. SEE MODIFIER -57.

ICD-10-CM Codes that Support Medical Necessity

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2020 R8

Under CPT/HCPCS Codes Group 1: Codes the code description was revised for CPT® code 97607. CPT® was inserted throughout the article where applicable. This revision is due to the Annual CPT®/HCPCS Code Update and becomes effective on 1/1/2020.

10/03/2019 R7

This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual. Under Article Title changed title from “Spiracur SNaP® Wound Care System” to “Billing and Coding: Spiracur SNaP® Wound Care System”. Under CPT/HCPCS Modifiers added modifier 25.

02/26/2018 R6 The Jurisdiction "J" Part A and Part B Contracts for Alabama (10111/10112), Georgia (10211/10212) and Tennessee (10311/10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these 6 contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 6 Part A and B contract numbers) have been completed in this revision.
12/14/2017 R5

Under Article Text removed all questions marks.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

11/23/2016 R4

Annual Review with no revisions made.

11/23/2016 R3 Under Article Text in the first paragraph added the words “Smart Negative Pressure” in front of the acronym “SNaP®”.
11/27/2015 R2 The registered trademark symbol was added to every notation of SNaP® throughout the article.
10/01/2015 R1 This article was consolidated into an A/B MAC Article. Under Article Text removed HCPCS codes G0456 and G0457 and added CPT Codes 97607 and 97608. Under CPT/HCPCS Codes added CPT codes 97607 and 97608. Due to the 2015 Annual CPT/HCPCS Update, HCPCS G0456 and G0457 were deleted.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
12/09/2019 01/01/2020 - N/A Currently in Effect You are here
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Keywords

  • Spiracur SNaP®