Healthcare Fraud Shield’s Latest Article: Don’t Feel the Pressure of Wound Therapy Billing

10 May

Negative Pressure Wound Therapy (NPWT) is a technique used to aid healing of burns, acute and chronic wounds to include, without limitation, diabetic wounds, pressure wounds, surgical wounds and burns. In negative pressure wound therapy, the provider uses an electrical pump to apply controlled subatmospheric pressure through a sealed dressing, which creates a vacuum around the wound to remove fluids and infectious materials and to promote healing.

Considerations
There are many considerations that vary from payer to payer. Many payers will have specific medical policies governing when NPWT would be acceptable, what interventions should be attempted prior to NPWT and what requirements are necessary to support ongoing therapy.

In many cases, ongoing therapy will need to demonstrate that the therapy is efficacious. This typically requires that the treating provider perform or supervise dressing changes, and report on the wound size and characteristics.

How is it billed?
It is billed using HCPCS (Healthcare Common Procedure Coding System) Code E2402: Negative pressure wound therapy electrical pump, stationary or portable.This code covers the supply of an electric pump used to provide negative pressure wound therapy.

What to look for
One of the most common red flags concerns how long the patient is using NPWT. A patient that extends beyond four (4) months of NPWT, may be worth additional review. This will be especially true if the provider has a pattern of a disproportionately high number of patients being billed for atypically long periods (4+ months).

Some Behaviors and KPIs to Examine
1) Frequency: How long is the course of NPWT?
2) Density: What percentage of patients have atypically long durations of NPWT?
3) Connectivity: What other services and/or conditions does the patient have? Prior to NPWT? Concurrent with NPWT?

If you have general SIU questions or comments, please contact us at SIU@hcfraudshield.com.

If you would like to learn more about Healthcare Fraud Shield’s analytics solution, contact us at info@hcfraudshield.com.

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