The Center for Medicare Management at the Centers for Medicare and Medicaid Services (CMS) requested this report from The Technology Assessment Program (TAP) at the Agency for Healthcare Research and Quality (AHRQ). AHRQ assigned this report to the following Evidence-based Practice Center: ECRI Institute EPC (Contract Number: 290-2007-10063). Section 154 (c) (3) of the Medicare Improvements for Patient and Providers Act (MIPPA) of 2008 calls for the Secretary of Health and Human Services to perform an evaluation of the Healthcare Common Procedure Coding System (HCPCS) coding decisions for Negative Pressure Wound Therapy (NPWT) devices. Specifically, the evaluation of existing HCPCS codes for NPWT should:
• ensure accurate reporting and billing for items and services under such codes; and
• use an existing process for the consideration of coding changes and consider all relevant studies and information furnished pursuant to such processes.
The HCPCS Level II coding system is a comprehensive, standardized system that classifies similar products that are medical in nature into categories for the purpose of efficient claims processing. Products are classified based on similarities in function and whether the products exhibit significant therapeutic distinctions from other products. Currently, all NPWT devices are classified into the same HCPCS codes. The Healthcare Common Procedures Coding System (HCPCS) code E2402 applies to the pump (NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE) and HCPCS code A6550 applies to the dressing sets (WOUND CARE SET, FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, INCLUDES ALL SUPPLIES AND ACCESSORIES). HCPCS code A7000 applies to the canister that goes with the pump. Negative pressure wound therapy (NPWT) applies a localized vacuum to draw the edges of the wound together while providing a moist environment conducive to rapid wound healing. The development of negative pressure techniques for wound healing is based on two theories: (1) the removal of excess interstitial fluid decreases edema and concentrations of inhibitory factors, and increases local blood flow; and (2) stretching and deformation of the tissue by the negative pressure is believed to disturb the extracellular matrix and introduce biochemical responses that promote wound healing. NPWT systems include a vacuum pump, drainage tubing, and a dressing set. The pump may be stationary or portable, may rely on AC or battery power, allows for regulation of the suction strength, has alarms to indicate loss of suction, and has a replaceable collection canister. The dressing sets may contain either foam or gauze dressing to be placed in the wound and an adhesive film drape for sealing the wound. The drainage tubes come in a variety of configurations depending on the dressings used or wound being treated.