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DPM,CWS
Wound VAC becoming uncovered Medicare service in Mid-West?
Section:  Wounds

Wisconsin Physician Services (WPS) covering Iowa, Kansas, Missouri and Nebraska is publishing an LCD to make the Wound VAC "non-covered modality" claiming a lack of evidence.

I am deeply troubled. I have personally witnessed many limbs and lives saved with Wound VAC therapy. How can they possibly ignore all the good RCT studies done by Dr. Armstrong and many others???

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L28572

Non-Covered Modalities:

Negative Pressure Wound Therapy (97605-97606): involves the application of controlled or intermittent negative pressure to a properly dressed wound cavity. Suction (negative pressure) is applied under airtight wound dressings to promote the healing of open wounds resistant to prior treatments. Negative pressure wound therapy facilitates the removal of excessive exudates that inhibit wound healing. Medicare coverage will no longer be considered for negative pressure wound therapy when it is used as an adjunct to surgery, an alternative to surgery, or a therapy for refractory chronic wounds.

http://www.ahrq.gov/clinic/ta/negpresswtd/

CMS partnered with Agency of Healthcare Research and Quality (AHRQ) to commission a review of NPWT devices to ensure all relevant studies and information on NPWT were captured.  ECRI Institute solicited information from stakeholders and searched literature in conducting this review. A draft report of their findings was published for comment in April 2009. After analysis of comments received, ECRI concluded that the available evidence does not support significant therapeutic distinction of a NPWT system or component of a system. The report informed CMS' HCPCS workgroup's decision. The final report will be publicly available no later than June 10, 2009 on AHRQ's homepage for the Technology Assessment Program at http://www.ahrq.gov/clinic/techix.htm.



Ultrasonic Wound Debridement: (CPT code 0183T) is a system that uses continuous low   frequency ultrasonic energy to atomize a liquid and deliver continuous low frequency ultrasound to the wound bed. This cleansing method is not considered a significantly separately payable coverable service by Medicare. Therefore Mist Therapy (CPT code 0813T) is included in the payment for the E&M or wound care services. Mist Therapy™ System 5.0 Wound Treatment Device is not covered.



The entire wound care LCD from WPS can be found
at  http://www.wpsmedicare.com/part_b/policy/

and search for " gsurg051_l28572.pdf  "

MEMBER COMMENTS
RE: Wound VAC becoming uncovered Medicare service in Mid-West

This lady was hit by a bus. Open fracture with gaping and degloving wound.

Healed completely in 3 month using Wound VAC. Was I able to do this with conventional treatments? I would say NO.

DSCN6556 DSCN7438DSCN2164

Re: Wound VAC becoming uncovered Medicare service in Mid-West

I don't see how CMS and the AHRQ could read the NUMEROUS studies on NPWT and come to the conclusion that this modality was not of significant value.  That is ridiculous.

 

This is especially ironic as the battle for health care reform wages on and the cost  of health care takes center stage. There are many studies which  demonstrate the significant cost savings associated with improved time-to-closure and decreased infection rates associated with the use of NPWT.....

 

Not being able to use NPWT is certainly going to cost more MONEY  in the long run, and (unfortunately) is also likely to cost some LIMBS!

 

RE: Wound VAC becoming uncovered Medicare service in Mid-West

I am afraid they may be mixing up Wound VAC and other newer "NPWT" devices that claim to be just as effective. It is true that those newer devices lack RCTs.

If they can pick-and-choose the RCTs and say "Wound VAC does not have enough clinical evidence," what's next? They can easily take away HBO, Skin substitute (Apligraf, Dermagraft, Oasis etc), or surgical debridement (!) from us and our patients.

Several years ago, the Blue Cross's technology review board tried to remove carbon monoxide poisoning from their HBO indication, by (conveniently) over-looking the NEJM article on an RCT done by Weaver et al (NEJM 2002, Vol 347: 1057-1067). As if "New England Journal of Medicine" is not important enough!

In this case, UHMS (Undersea Hyperbaric Medical Society) fought back and got the indication re-instated. I think we have to unite and fight back... or rather, let them realize their mistake of taking an effective therapy away from us and our patients.

RE: Wound VAC becoming uncovered Medicare service in Mid-West

Very interesting

RE: Wound VAC becoming uncovered Medicare service in Mid-West?

I've read the report in depth, and this is what I found out.

http://www.ahrq.gov/clinic/ta/negpresswtd/npwtd01.htm

(1). The original ECRI report was to investigate the clinical evidence of various NPWT devices as compared to each other (see under the Methods of the Review).

(2). No studies directly comparing one NPWT system to another NPWT system were identified that addressed the "Key Questions" (In fact, there was no RCT available for non-KCI device, so no comparison could be made.)

Quote: “After analysis of comments received, ECRI concluded that the available evidence does not support significant therapeutic distinction of a NPWT system or component of a system.”

(3). WPS (Wisconsin Physicians Services) appears to misinterpret the report above, saying that available evidence does not support the use of NPWT and therapeutic distinction compared to the conventional wound care treatment. (... therefore, it should be a non-covered service)

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I was told that the Alliance of Wound Care is aware and taking up the issue.

It seem to me that it may be a matter of miscommunication, as opposed to a malicious attempt by the "powers-that-be" to take away Wound VAC from us. 


Will keep you posted... 

RE: Wound VAC becoming uncovered Medicare service in Mid-West?

The update of the WPS (Mid-West Medicare) debacle with "NPWT becoming non-covered service."

KCI officially says it was a case of misinterpretation and they are confident to reverse their decision (which is not finalized yet).

Again, sorry for the excitement. I am taking a big sigh of relief.

Wisconsin Physician Services (WPS), the Medicare contractor for physician services in Illinois, Iowa, Wisconsin, Michigan, Minnesota, Missouri, Nebraska, and Kansas. The Clinicians practicing in the states covered by the WPS policy are encouraged to share their personal concerns with WPS at the following address:

Stephen Boren, MD, MBA
Contractor Medical Director
Wisconsin Physician Services
111 East Wacker Drive, #950
Chicago, IL 60611 
 

RE: Wound VAC becoming uncovered Medicare service in Mid-West?

I hope that is the case! I also contacted KCI about this here in Texas and they are checking with the reimbursement people but I have not yet heard back.  

I could not imagine that this would be the case. As you know, while the "VAC wanna be's" have not gone through the same rigorous evidence-based  trials they have been trying to suggest their product has been through those same trials. I thought that perhaps that was the source of the problem.   I will post anything else I here from here, Kazu. Thanks for the update.

Re: Wound VAC becoming uncovered Medicare service in Mid-West?

I just found out that WPS has reversed their decision and will be covering NPWT as per their previous guidelines.

RE: Wound VAC becoming uncovered Medicare service in Mid-West?

Thanks, Lee. This is excellent news, not as much for us as it is for the patients who so often have no place else to turn in order to build those masses of sturdy, viable granulation tissue that are the framework for the reconstuction of the foot.

This is definitely great news and I know a lot of patients and physicians welcoming this news.

RE: Wound VAC becoming uncovered Medicare service in Mid-West?

Thanks, Lee. That's great news.

What's curious is how WPS misinterpreted the original report, stating that they could not compare one NWPT against the others, since the KCI device is the only one with the RCT data. 

I do encourage the other NWPT device companies to fund more clinical studies (not just case studies) to prove their points. In other words, I or any other conscientious clinicians won't use non-KCI NPWT device until they do so.  

   

Re: Wound VAC becoming uncovered Medicare service in Mid-West?

I just heard that this was apparently a rumor that got distributed and it got out of hand, as of right now, no coverage regarding the VAC has been changed in texas from what I can see, The use of this medical device is vital in some of the major Diabetic Ulcers and especially some of the Gunshut wounds that I have seen presented here..

WPS Rescinds Non Coverage Policy for NPWT

It wasn't a rumor. It was very real problem in Mid-West. The bottom line, their reasoning for making NPWT non-covered service wasn't sound, and they quickly reversed their position.

Here's the official response from WPS below.

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WPS Rescinds Non Coverage Policy for NPWT:

we have concluded that we were premature in our assessment of this technology. As result the LCD will be changed back to the original description of NPWT   as in the current policy which is being retired at the end of this month. Since the effective date for the new policy is 9-1-2009 this will not cause any inappropriate denial in claims.  I will contact the appropriate people to ensure that this information is placed on the WPS ListServ and is published in the next Communiqué.

The LCD L28572 Wound Care (GSURG-051) will now read as the same language as before which is in the current policy.

We apologize for the inconsistancy.

Barbara Kahler, RN
Medical Policy Coordinator
Wisconsin Physicians Service

RE: Wound VAC becoming uncovered Medicare service in Mid-West?

Hurray !  Don't you love when the good guys win ?

 

Thanks for the great news gathering and reporting here, guys...