Patients who need negative-pressure wound therapy (NPWT) and reside in their homes appreciate the freedom they enjoy when their wounds/ulcers qualify for the use of disposable NPWT rather than NPWT durable medical equipment (DME). Although coding/billing for disposable NPWT is straightforward, many home health agencies (HHAs) and hospital-owned outpatient wound management provider-based departments (PBDs) make coding and billing mistakes. Some HHAs and PBDs even choose not to provide and/or code/bill for disposable NPWT! That is unfortunate for the agencies, outpatient departments, and patients. Therefore, this article reviews some of the common disposable NPWT coding/billing mistakes and offers some tips for implementing/improving your coding/billing processes to include disposable NPWT.
Disposable NPWT Mistakes and Tips for HHAs
All HHAs are required to purchase surgical dressings for their patients, but they are not required to purchase NPWT DME. The DME suppliers (1) provide the NPWT DME and supplies to the patients, (2) submit claims for the items to the appropriate DME Medicare Administrative Contractor (MAC), and (3) collect the 20% copayment from the patients or their secondary insurance.
Because disposable NPWT does not meet DME criteria, DME suppliers cannot bill Medicare for it. Therefore, when disposable NPWT was first released to the market, HHAs had to purchase the equipment and supplies out of their home health resource group payment, which was not sufficient to cover the cost of the disposable NPWT equipment and supplies.
Because Congress wants to encourage healthcare technology innovation, effective January 1, 2017, they revised the HHA payment system to allow HHAs to (1) submit separately payable claims (in addition to their HHA episode of care claims) to their MACs for disposable NPWT and (2) to collect the 20% copayment from Medicare patients or their secondary insurance. The HHAs were instructed to report the same codes as the PBDs and informed that their Medicare payment would equal the Outpatient Prospective Payment System (OPPS) rates paid to PBDs (Table 1).
Even though Congress gave the HHAs a fabulous opportunity to provide disposable NPWT to their homebound patients and receive additional payment for the service, and even though the coding and billing seem straightforward, some HHAs continue to make coding/billing mistakes. See Table 2 for the most common HHA disposable NPWT coding/billing mistakes and some tips for improvement. For more information and helpful scenarios, see the following:
1. Implementation of Policy Changes for the CY 2017 Home Health Prospective, http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMatte
2. Clarification of Billing and Payment Policies for Negative Pressure Wound Therapy (NPWT) Using a Disposable Device, http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMatte
Disposable NPWT Mistakes and Tips for PBDs
All PBDs are required to purchase the surgical dressings that are applied to patients in the department. Like HHAs, the PBD is not required to purchase NPWT DME and supplies for the patients. Instead, the DME suppliers (1) provide the NPWT DME and supplies to the patients, (2) submit claims for the items to the appropriate DME MAC, and (3) collect the 20% copayment from the patients or their secondary insurance.
When patients go to the PBD for appointments, they bring their NPWT DME and fresh canisters/dressings. The PBD can use those NPWT supplies because they are part of the DME equipment that patients use at home. NOTE: The PBD cannot use surgical dressings that the patients bring from home. As stated earlier, PBDs must purchase surgical dressings for use in the department and cannot charge the Medicare patient for the surgical dressings.
Before the disposable NPWT codes were created and their OPPS payment rates were released, PBDs had to purchase the disposable equipment and supplies using their OPPS payment for the service and/or procedure they provided to the patient; most of the OPPS payments were not large enough to pay for the service and/or procedure as well as for the disposable NPWT equipment and supplies. Therefore, PBDs welcomed the creation of the disposable NPWT codes and the OPPS payment for the application of disposable NPWT (Table 1).
Even though the coding and billing seem straightforward, some PBDs continue to make coding/billing mistakes. See Table 3 for the most common PBD disposable NPWT coding/billing mistakes and some tips for improvement.