How to Select the Appropriate Negative Pressure Wound Therapy Device for Your Patient
by Samantha Kuplicki, MSN, APRN-CNS, ACNS-BC, CWS, CWCN, CFCN
Recently, we've reviewed application and documentation strategies for negative pressure wound therapy (NPWT), but what about navigating the different systems currently on the market? We know all devices have the mechanism of negative pressure in common, but what other characteristics need to be considered when selecting the right device for your patient? In this installment, we will become better acquainted with the characteristics of NPWT devices and how they differ for various systems.
Powered NPWT devices may operate on a rechargeable battery, disposable batteries, or on outlet power. These devices are sometimes heavier, larger, and louder due to presence of an electronic pump mechanism. Non-powered NPWT devices use the mechanical technology of energy from a spring mechanism, which reduces air density within an enclosure in a controlled manner by offering a continuous, controlled vacuum for exudate. The absence of an electrical pump allows for silent delivery of therapy, as well as a smaller, lighter device.
Indication for Use
Some units are specifically geared for single purposes such as post-surgical incision management, or very lightly exuding wounds. Others boast a much wider range of indications, spanning nearly every imaginable wound etiology.
Canister collection is a method of exudate management common to many NPWT devices, and is very effective in managing wounds with moderate to heavy exudate; some devices offer more than one canister capacity. Canisters may either be replaceable or contained inside a disposable NPWT unit. Other NPWT devices collect the exudate inside the dressing system.
Some devices are designed with a customizable dressing medium to allow for adaptation to a wide range of wounds with respect to size, depth, exudate amount, etc. Others are not customizable, and are only indicated for use in wounds with specific depths or other characteristics. For example, a device that comes with a “peel and stick” gauze interface dressing may not be appropriate for a deep diabetic/neuropathic ulcer with undermining, despite being indicated for that wound type. Most dressing mediums are comprised of hydrocolloids, various types of foam, and gauze.
Dressing Change Frequency
While some operate on a 3 times per week dressing change schedule, others recommend 2 times weekly. Incisional management systems, or other devices that are indicated for very small exudate, can remain intact up to 7 days.
Negative Pressure Settings
Most devices range from approximately -25mmHg to -200mmHg pressure delivery. Some have multiple settings, while others are limited to one. Additionally, some devices allow modulation of negative pressure delivery: continuous (therapy continually delivered at specified setting), intermittent (customization of ‘on’ and ‘off’ therapy intervals), or variable (the unit slowly alternates between a set high and low pressure at specified intervals; some systems retain a higher negative pressure in the ‘off’ or ‘low’ state to preserve dressing seal and exudate evacuation).
Reimbursement Coding/Billing Mechanism
For devices considered durable medical equipment (DME) (multiple-use), a third party company is reimbursed through a DME benefit via insurance for a reusable device with replaceable exudate collection canister and dressings. For a non-DME (single use/disposable) device, the facility/provider office purchases a device with the expectation of being reimbursed by billing a CPT and/or HCPCS code which includes the cost of the device. Interestingly, some disposable NPWT devices are considered surgical dressings for billing purposes.
The topic of reimbursement for NPWT can be fairly complex; it varies by payor, care setting, provider, and facility policy. Some payors may request certain products be billed as DME, whereas others may require the same product to be submitted for reimbursement under a Current Procedural Terminology (CPT®) code, which is intended to include the cost for the device, supplies, and application. It is prudent to have foreknowledge of these variables before purchasing or applying devices to patients to prevent interruption of therapy or loss of revenue.
The following CPT codes are associated with NPWT device application:
97605: Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session, total wound(s) surface area less than or equal to 50 square centimeters
97606: Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session, total wound(s) surface area greater than 50 square centimeters
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
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 wounds(s) surface area greater than 50 square centimeters
*97607 and 97608 replace the previous G0456 and G0457 therapy codes. The 97607 and 97608 codes include the pump, dressing and canister, and can only be billed when the entire system is provided to the patient. These two codes should not be used if only a dressing change is performed for a disposable NPWT system.
The following Healthcare Common Procedure Coding System (HCPCS) codes are used to report cost of devices (these will be used either by the DME provider who is billing the payor directly, or by facility applying the device):
A6550: Wound care set for negative pressure wound therapy electrical pump, includes all supplies and accessories
A7000: Canister disposable, used with suction pump, each
A9272: Suction, disposable, includes dressing, all accessories and components, any type, each (products reported with this code are not covered by Medicare)
E2402: Negative pressure wound therapy electrical pump, stationary or portable
Many clinicians hesitate to step outside their comfort zone with respect to device manufactures, simply because familiarizing oneself with new technology is often time consuming. However, cost and time savings can be realized when the clinician is apprised of the differing indications and varying features and benefits among NPWT systems.
About the Author
Samantha Kuplicki is board certified in wound care by both the American Board of Wound Management as a Certified Wound Specialist (CWS) and by the Wound, Ostomy and Continence Certification Board as a Certified Wound Care Nurse (CWCN) and Certified Foot Care Nurse (CFCN). She serves on the American Board of Wound Management (ABWM) Examination Committee and also volunteers for the Association for the Advancement of Wound Care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.