RETIRED - Correct Coding - Negative Pressure Wound Therapy (NPWT)

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Joint DME MAC Publication

Posted December 15, 2016

Recently it has come to the attention of the DME MACs that suppliers are billing separately for wound dressings and related dressing change items used with negative pressure wound therapy pumps (HCPCS code E2402).  As noted in the Negative Pressure Wound Therapy Local Coverage Determination (LCD) and related Policy Article (PA) (effective 10/01/2015*), the allowance for wound dressings HCPCS code A6550 includes all items necessary for the effective utilization of the wound pump.  The NPWT LCD related PA coding guideline states:

Code A6550 describes an allowance for a dressing set which is used in conjunction with a stationary or portable NPWT pump (E2402). A single code A6550 is used for each single, complete dressing change, and contains all necessary components, including but not limited to any separate, non-adherent porous dressing(s), drainage tubing, and an occlusive dressing(s) which creates a seal around the wound site for maintaining sub-atmospheric pressure at the wound. [Emphasis Added]

*This long-standing bundling provision has been effective since 10/01/2011.

Suppliers must not bill separately for any components of code A6550 including, but not limited to:

  • any dressing type ( impregnated gauze, hydrogels, specialty absorptive dressings or other adherent or non-adherent dressings, etc.)
  • antiseptics
  • anesthetics
  • gloves
  • tubing
  • adhesives
  • any other item necessary to perform a complete dressing change associated with a negative pressure wound pump.

Claims for dressing-related items used in conjunction with code E2402 and billed separately will be denied as unbundling.

Refer to the Negative Pressure Wound Therapy LCD and related Policy Article for additional information about coverage, documentation, and coding.

For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) contractor at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form at https://www.dmepdac.com/.

 

Last Updated Thu, 10 Jan 2019 13:04:59 +0000