Randall R. Carson
Randall R. Carson

Negative Pressure Wound Therapy (“NPWT”) is one of the oldest forms of medicinal therapy used to heal the human body. Over the past decade there has been a significant increase in the use of this therapy.

Today NPWT provides clinicians with an important option for the advanced management of a variety of chronic and acute wounds. The first products on the market consisted of an external vacuum pump, a fluid collection container, drainage tubing, and a dressing set. The latest wave of innovation has brought the simplicity of disposable NPWT to the market, adding an additional option of ease, and comfort.

The Centers for Medicare & Medicaid Services has released policy guidance on billing for services using single NPWT products, such as Smith & Nephew’s leading PICO Single Use Negative Pressure Wound Therapy System and KCI’s V.A.C. Via™ Therapy System. Two specific G codes describing NPWT services – G-0456 and G-0457 – created in January, may be used by providers submitting claims for disposable NPWT, including the PICO system. G codes are used to identify professional health care procedures and services that would otherwise be coded in Current Procedural Terminology (CPT) but for which there are no CPT codes.

CMS’s decision to specify that the G codes are intended for disposable NPWT products is great news for patients, physicians and health institutions as it grants Medicare patient access to these services. The decision is in part an acknowledgment of the importance of single-use NPWT in addressing wounds.

Two studies completed in the United States and the United Kingdom indicate how valuable disposable NPWT can be as a potential tool. The studies examined strategies to reduce complications associated with healing after cesarean sections.

In the U.S. study, clinicians introduced a new post-operative strategy to manage C-sections including using PICO for high risk patients. Analysis showed an 83% reduction in surgical site infections, arriving at a rate of 0.5 percent or six surgical site infections out of a total of 1,200. A similar change in treatment approach at a hospital in the U.K. resulted in no infections and zero re-admissions.

Medicare has set a hospital outpatient payment rate of $209.65 for hospitals paid  under the Ambulatory Payment Classification (APC)system. This payment is separate from the Medicare physician payment..

Randall R. Carson is the director of government affairs & reimbursement at Smith & Nephew Wound Management, N.A.