Pressure ulcers are a serious health issue, leading to clinical, financial, and emotional challenges. Numerous treatment modalities are available to promote wound health, yet clinicians may be unsure how to incorporate these treatment options into an overall plan of care for the patient with a pressure ulcer. A consensus panel of experienced wound care clinicians convened in July 2004 to review the mechanisms of action and research basis for one such treatment modality: negative pressure wound therapy (NPWT). The only Food and Drug Administration (FDA)-cleared NPWT device is the VAC Therapy System (Kinetic Concepts, Inc., San Antonio, Texas).
After answering key questions about NPWT, they developed an algorithm to assist the clinician in making decisions about using NPWT appropriately in patients with stage III or IV pressure ulcers.
Technologic advances have given clinicians a myriad of options for managing pressure ulcers, which can lead to improved outcomes of care. In the case of NPWT, some clinicians still do not know the best way to use this modality in an overall pressure ulcer treatment strategy. The group of expert clinicians reviewed the literature, evaluated best practices, developed consensus on clinical guidelines, and identified priorities for future research.
The supplement provides an overview of the incidence, prevalence, and etiology of pressure ulcers; the financial and human cost of care; best practices for staging and treatment; and a thorough review of the literature, types of wounds, and guidelines for NPWT using an algorithm for the complete treatment process, as well as guidelines for using NPWT foam. Interspersed throughout the document are Clinical Pearls that provide tips for clinicians in effectively using this therapy for best outcomes.
Guidelines for Managing Pressure Ulcers With Negative Pressure Wound Therapy was published as a supplement to Advances in Skin & Wound Care (2004, Volume 7, Supplement 2, Nov/Dec). It can be accessed through the Advances Web site at http://www.woundcarejournal.com and on the Lippincott Williams & Wilkins Web site, http://www.Nurs-ingCenter.com (click on journals, then click on Supplements to find the listing).
A Reminder of Medicare Coverage for NPWT Therapy
The latest list of HCPCS (Healthcare Common Procedure Coding System) codes used for home health consolidated billing, effective January 2005, included new codes 97605 and 97606. The description of these codes is "negative pressure wound therapy" (i.e., vacuum-assisted drainage collection). Wound VAC equipment and supplies are not part of home health consolidated billing; they continue to be paid under the durable medical equipment (DME) benefit. DME suppliers will continue to submit claims for wound VAC equipment and supplies, using the same codes that they have always used when billing Medicare:
* Canister set: A6551
* Dressing set: A6550
* Pump: E2404
Confusion surrounding this issue arose because the Centers for Medicare & Medicaid Services (CMS) assigned codes 97605 and 97606 to wound vac treatments when provided by therapists. These codes were established because certain therapy providers (other than home health agencies) are required to use HCPCS codes to describe treatment modalities on Medicare claims. The two new codes are limited to use by these therapy providers when billing for clinical services. They are not intended for billing equipment and supplies.
CMS included the wound vac therapy codes on the bundled service list and added them to claim edits. This was intended to ensure that if claims are submitted by therapy providers for these services while a patient is under a home health plan of care, the claims will be rejected because therapy services must be bundled under the home health prospective payment system (PPS).