Billing and Coding Article

Billing and Coding: Spiracur SNaP^® Wound Care System

A53781

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Palmetto GBA	A and B MAC	10111 - MAC A	J - J	Alabama
Palmetto GBA	A and B MAC	10112 - MAC B	J - J	Alabama
Palmetto GBA	A and B MAC	10211 - MAC A	J - J	Georgia
Palmetto GBA	A and B MAC	10212 - MAC B	J - J	Georgia
Palmetto GBA	A and B MAC	10311 - MAC A	J - J	Tennessee
Palmetto GBA	A and B MAC	10312 - MAC B	J - J	Tennessee
Palmetto GBA	A and B and HHH MAC	11201 - MAC A	J - M	South Carolina
Palmetto GBA	A and B and HHH MAC	11202 - MAC B	J - M	South Carolina
Palmetto GBA	A and B and HHH MAC	11301 - MAC A	J - M	Virginia
Palmetto GBA	A and B and HHH MAC	11302 - MAC B	J - M	Virginia
Palmetto GBA	A and B and HHH MAC	11401 - MAC A	J - M	West Virginia
Palmetto GBA	A and B and HHH MAC	11402 - MAC B	J - M	West Virginia
Palmetto GBA	A and B and HHH MAC	11501 - MAC A	J - M	North Carolina
Palmetto GBA	A and B and HHH MAC	11502 - MAC B	J - M	North Carolina

Article Information

General Information

Article ID
A53781

Article Title
Billing and Coding: Spiracur SNaP^® Wound Care System

Article Type
Billing and Coding

Original Effective Date
10/01/2015

Revision Effective Date
01/01/2024

Revision Ending Date
N/A

Retirement Date
N/A

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

Article Guidance

Article Text

Effective for dates of service on and after January 1, 2013, Palmetto GBA will reimburse Smart Negative Pressure (SNaP^®), a process that combines a suction device with an advanced hydrocolloid wound dressing. SNaP^® delivers constant and controlled levels of negative pressure to facilitate the healing of the following types of open wounds:

•Stage III and IV pressure ulcer
•Neuropathic (diabetic) ulcer
•Chronic (present for at least 30 days) ulcer of mixed etiology
•Venous or arterial insufficiency ulcer
•Complications of a surgically created wound
•Traumatic wound

Palmetto GBA expects providers to utilize all accepted wound care standards prior to using SNaP^®.

Accepted wound care standards include the following:

•Patient turning and positioning
•Appropriate surface modalities to prevent pressure wounds
•Appropriate management of moisture and incontinence
•Consistent application of compression garments and/or bandages
•Leg elevation and ambulation
•Appropriate topical wound treatments
•Appropriate necrotic tissue debridement
•Nutritional status evaluation with appropriate intervention

The patient medical record maintained by the health care professional must include the following patient-specific information:

•Physician order for treatment
•Documentation to substantiate standard protocols have been met
•Wound description including specific measurements and condition
•Patient-specific treatment plan

Coding/Billing Guidelines

CMS 1500 Form
An evaluation/management (E/M) service may be billed using the appropriate E/M CPT^® code appended with the 25 modifier. The E/M service may only be submitted when a separately identifiable service is performed besides the negative pressure wound therapy. If the patient's condition warrants an additional E/M service, the medical record must document the medical necessity for the E/M service including the following:

•Wound description including specific measurements and condition
•Change in patient status
•A simple check of the wound does not justify an additional E/M service and will be denied as not reasonable or necessary
•CPT^®code:

97607 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s) wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters), or

97608 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s) wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters)

*NOTE: CPT^® Codes 97607 and 97608 are not specific to the Spiracur SNaP^® Wound Care System. These CPT codes apply to any equivalent product. If a disposable negative pressure wound therapy (NPWT) product is used that meets the same specifications as the Spiracur SNaP^® Wound Care System, but is a different product, the product name should be entered in the Narrative field on the CMS 1500 Form.

UB-04 (CMS 1450 form) - Outpatient Treatment
To report a SNaP^® treatment in the outpatient setting, submit the following:

•CPT^® code:

•Enter 'Spiracur SNaP^® device' in the Remarks field (field locator 80) on the UB-04 (CMS 1450 form)

*NOTE: CPT^® Codes 97607 and 97608 are not specific to the Spiracur SNaP^® Wound Care System. These CPT codes apply to any equivalent product. If a disposable negative pressure wound therapy (NPWT) product is used that meets the same specifications as the Spiracur SNaP^® Wound Care System, but is a different product, the product name should be entered in the Remarks field (field locator 80) on the UB-04 (CMS 1450 form).

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

Code	Description
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Revenue Codes

Code	Description
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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1

(1 Code)

Group 1 Paragraph

N/A

Group 1 Codes

Code	Description
25	SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE: THE PHYSICIAN MAY NEED TO INDICATE THAT ON THE DAY A PROCEDURE OR SERVICE IDENTIFIED BY A CPTCODE WAS PERFORMED, THE PATIENT'S CONDITION REQUIRED A SIGNIFICANT, SEPARATELY IDENTIFIABLE E/M SERVICE ABOVE AND BEYOND THE OTHER SERVICE PROVIDED OR BEYOND THE USUAL PREOPERATIVE AND POSTOPERATIVE CARE ASSOCIATED WITH THE PROCEDURE THAT WAS PERFORMED. THE E/M SERVICE MAY BE PROMPTED BY THE SYMPTOM OR CONDITION FOR WHICH THE PROCEDURE AND/OR SERVICE WAS PROVIDED. AS SUCH, DIFFERENT DIAGNOSES ARE NOT REQUIRED FOR REPORTING OF THE E/M SERVICES ON THE SAME DATE. THIS CIRCUMSTANCE MAY BE REPORTED BY ADDING THE MODIFIER -25 TO THE APPROPRIATE LEVEL OF E/M SERVICE, OR THE SEPARATE FIVE DIGIT MODIFIER 09925 MAY BE USED. NOTE: THIS MODIFIER IS NOT USED TO REPORT AN E/M SERVICE THAT RESULTED IN A DECISION TO PERFORM SURGERY. SEE MODIFIER -57.

ICD-10-CM Codes that Support Medical Necessity

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code	Description
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N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code	Description
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N/A

Other Coding Information

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
01/01/2024	R9	Under *CPT/HCPCS Codes Group* 1: Codes the description was revised for 97607 and 97608. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/24. Under *CMS National Coverage Policy* added the following regulation: Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim. Formatting and punctuation errors were corrected throughout. This revision is effective 1/1/24.
01/01/2020	R8	Under *CPT/HCPCS Codes Group 1: Codes* the code description was revised for CPT^® code 97607. CPT^® was inserted throughout the article where applicable. This revision is due to the Annual CPT^®/HCPCS Code Update and becomes effective on 1/1/2020.
10/03/2019	R7	This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual. Under *Article Title* changed title from “Spiracur SNaP^® Wound Care System” to “Billing and Coding: Spiracur SNaP^® Wound Care System”. Under *CPT/HCPCS Modifiers* added modifier 25.
02/26/2018	R6	The Jurisdiction "J" Part A and Part B Contracts for Alabama (10111/10112), Georgia (10211/10212) and Tennessee (10311/10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these 6 contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 6 Part A and B contract numbers) have been completed in this revision.
12/14/2017	R5	Under *Article Text* removed all questions marks. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.
11/23/2016	R4	Annual Review with no revisions made.
11/23/2016	R3	Under *Article Text* in the first paragraph added the words “Smart Negative Pressure” in front of the acronym “SNaP^®”.
11/27/2015	R2	The registered trademark symbol was added to every notation of SNaP^® throughout the article.
10/01/2015	R1	This article was consolidated into an A/B MAC Article. Under Article Text removed HCPCS codes G0456 and G0457 and added CPT Codes 97607 and 97608. Under CPT/HCPCS Codes added CPT codes 97607 and 97608. Due to the 2015 Annual CPT/HCPCS Update, HCPCS G0456 and G0457 were deleted.

Associated Documents

Updated On	Effective Dates	Status
01/11/2024	01/01/2024 - N/A	Currently in Effect	You are here
12/09/2019	01/01/2020 - 12/31/2023	Superseded	View
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Keywords

Spiracur SNaP^®

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Billing and Coding: Spiracur SNaP® Wound Care System

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Note History

Contractor Information

Article Information

General Information

CMS National Coverage Policy

Article Guidance

Response To Comments

Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

ICD-10-CM Codes that Support Medical Necessity

Group 1

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

ICD-10-PCS Codes

Group 1

Additional ICD-10 Information

Bill Type Codes

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Other Coding Information

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Coding Table Information

Revision History Information

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Billing and Coding: Spiracur SNaP^® Wound Care System