The Center for Medicare Management at the Centers for Medicare and Medicaid Services (CMS) requested this report from The Technology Assessment Program (TAP) at the Agency for Healthcare Research and Quality (AHRQ). AHRQ assigned this report to the following Evidence-based Practice Center: ECRI Institute EPC (Contract Number: 290-2007-10063).
Section 154 (c) (3) of the Medicare Improvements for Patient and Providers Act (MIPPA) of 2008 calls for the Secretary of Health and Human Services to perform an evaluation of the Healthcare Common Procedure Coding System (HCPCS) coding decisions for Negative Pressure Wound Therapy (NPWT) devices. Specifically the evaluation of existing HCPCS codes for NPWT should:
ensure accurate reporting and billing for items and services under such codes; and
use an existing process for the consideration of coding changes and consider all relevant studies and information furnished pursuant to such processes.
The HCPCS Level II coding system is a comprehensive, standardized system that classifies similar products that are medical in nature into categories for the purpose of efficient claims processing. Products are classified based on similarities in function and whether the products exhibit significant therapeutic distinctions from other products. Currently, all NPWT devices are classified into the same HCPCS codes. The Healthcare Common Procedures Coding System (HCPCS) code E2402 applies to the pump (NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE) and HCPCS code A6550 applies to the dressing sets (WOUND CARE SET, FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, INCLUDES ALL SUPPLIES AND ACCESSORIES). HCPCS code A7000 applies to the canister that goes with the pump.