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).
