Important Excerpt from the Medicare Claims Processing Manual. Please review the full article for important information and tips to avoid duplicate payments:
To avoid duplication of payment, for instances where the sole purpose for an HHA visit is to perform NPWT using a disposable device, Medicare will not pay for a skilled nursing or therapy visit under the HH PPS. Rather, performing NPWT using a disposable device for a patient under a home health plan of care is be separately reimbursed the OPPS amount. In this situation, the HHA bills only under TOB 034x. This visit is not reported on the HH PPS claim (TOB 032x).
Key parts for using Barnestorm related to visit code / billing of disposable negative pressure wound therapy
- Adding Medicare Part B as a payer on the patient's referral
- Using Medicare Part B payer on the visit for billing
- Using the appropriate job code with HCPCS code 97607 or 97608
Adding the correct payer to the Referral > Payers tab
- Pull the patient up from Select Patient screen.
- Go to Referrals > Payers and select the next available payer.
- Add the Medicare B payer with the patient’s Medicare number in the HIC# field.
- Click on Save Payer and then Save Patient Data.
Adding a scheduled visit for the patient
Start the schedule as you normally would. Here are key points to pay attention to:
- Payer code: Select Medicare B as the payer. If Medicare B is not an option from the list, go to the referral to add the payer.
- Job Code: Select the job code with the correct HCPCS 97607 or 97608. You may try searching for a key word ‘NPWT’ if you do not know the 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.
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.
- Visit Status: Select a visit status specific to wound assessment OR a general code your agency has designated.
- Visit Type: Select a type specific to wound OR a general code your agency has designated.
Point-of-Care User
If the POC user is starting the visit from the Visits/Assessment screen
- Assessment Type: Select a type specific to wound OR a general code your agency has designated.
- Payer: It’s important to select Medicare B as the payer. If Medicare B is not on the list to select from, ask an office staff to add the payer to the patient’s referral.
- Job Code: Select the correct job code based on the total wound size.
- MEDICARE NPWT RN <=50CM or MEDICARE NPWT RN >=50cm.
- Visit Status: Select a visit status specific to wound assessment OR a general code your agency has designated.
Billing
It is important for the biller to know what to look for when billing for negative pressure wound services.
The claims will generate on a 34X type of bill. Make sure the payer and job code are correct for the visit. You can use the feature under Admin > Correct Visit Info if the codes are incorrect.