BlueCross BlueShield of Tennessee Medical Policy Manual

Negative Pressure Wound Therapy in the Outpatient Setting

DESCRIPTION

Negative pressure wound therapy (NPWT) consists of the use of a negative pressure or suction device to aspirate and remove fluids, debris, and infectious materials from the wound bed to promote the formation of granulation tissue. NPWT uses a specialized dressing and vacuum drainage to remove blood or serous fluid from a wound or surgical site while maintaining a moist wound environment. It is delivered through an integrated system of a suction pump, separate exudate collection chamber and dressing sets to a qualified wound. When the exposed end of the drain tube is connected to sub-atmospheric pressure or a vacuum source, fluid is drawn from the wound through the foam into a reservoir, for subsequent disposal.

Negative pressure wound therapy may be delivered using mechanically powered or electrically powered devices. Non-powered (mechanical) devices are designed to be light-weight, disposable, and may be worn underneath clothing.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Evidence from comparative clinical trials demonstrated that use of NPWT may provide a significant clinical benefit in a subset of problematic wounds. Due to clinical variability, it is not possible to determine prospectively which wounds are most likely to respond favorably to NPWT. For this reason, a thirty day therapeutic trial of NPWT is considered medically appropriate for chronic wounds that have failed to heal despite intense conventional wound therapy.

Current studies of a small number of individuals using the non-powered (mechanical) gauze-based NPWT system are insufficient to draw conclusions about its impact on net health outcome. Well-designed comparative studies with larger numbers of individuals are needed. 

SOURCES 

Acosta, S., Björck, M., & Petersson, U. (2017). Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy - a systematic review. Anaesthesiology Intensive Therapy, 49 (2), 139-145. Abstract retrieved June 26, 2017 from PubMed database.

American College of Physicians. (2015). Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Retrieved June 25, 2018 from https://www.acponline.org/clinical-information/guidelines.

BlueCross BlueShield Association. Evidence Positioning System. (2:2019). Negative pressure wound therapy in the outpatient setting. (1.01.16) Retrieved July 15, 2019 from https://www.evidencepositioningsystem.com/.  (48 articles and/or guidelines reviewed)

CGS Administrators, LLC. (2017, January). Local Coverage Article: Pressure reducing support surfaces - group 3 - policy article (A52468). Retrieved June 25, 2018 from www.cms.gov.

CGS Administrators, LLC. (2017, May). Local Coverage Article: Pressure reducing support surfaces - group 2 - policy article (A52490). Retrieved June 25, 2018 from www.cms.gov.

CGS Administrators, LLC. (2017, May). Local Coverage Determination: Negative pressure wound therapy pumps (L33821). Retrieved June 25, 2018 from www.cms.gov.

DeVries, F., Wallert, E., Solomkin, J., Allegranzi, B., Egger, M., Dellinger, E., & Boermeester, M. (2016). A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery. Medicine, 95 (36), e4673. Abstract retrieved June 26, 2017 from PubMed database.

Kim, J.H., Kim, H.J., & Lee, D.H. (2019). Comparison of the efficacy between closed incisional negative-pressure wound therapy and conventional wound management after total hip and knee arthroplasties: a systematic review and meta-analysis. Journal of Arthroplasty, doi: 10.1016/j.arth.2019.06.020. Abstract retrieved July 15, 2019 from PubMed database. [Epub ahead of print]

Li, H.Z., Xu, X.H., Wang, D.W., Lin, Y.M., Lin, N., & Lu, H.D. (2019). Negative pressure wound therapy for surgical site infections: a systematic review and meta-analysis of randomized controlled trials. Clinical Microbiology and Infection, doi: 10.1016/j.cmi.2019.06.005. Abstract retrieved July 15, 2019 from PubMed database. [Epub ahead of print]

Liu, S., He, C., Cai, Y., Xing, Q., Guo, Y., Chen, Z, et al. (2017). Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and analysis. Therapeutics and Clinical Risk Management, 13, 533-534. (Level 2 evidence)

National Institute for Health and Care Excellence. (2013, November). Negative pressure wound therapy for the open abdomen. Retrieved October 7, 2015 from: http://www.nice.org.uk/ipg467.

National Institute for Health and Care Excellence. (2014, April). Pressure ulcers: prevention and management. Retrieved June 25, 2018 from http://www.nice.org.uk/guidance/cg179.

National Institute for Health and Care Excellence. (2015, August). Diabetic foot problems: prevention and management. Retrieved June 25, 2018 from http://www.nice.org.uk/guidance/ng19.

Sahebally, S.M., McKevitt, K., Stephens, I., Fitzpatrick, F., Deasy, J., burke, J.P., & McNamara, D. (2018). Negative pressure wound therapy for closed laparotomy incisions in general and colorectal surgery: a systematic review and  meta-analhysis. Journal American Medical Association Surgery, 153 (11), e183467. Abstract retrieved July 15, 2019 from PubMed database.

Tricco, A., Antony, J., Vafaei, A., Khan, P., Harrington, A., Cogo, E., et al. (2015). Seeking effective interventions to treat complex wounds: an overview of systematic reviews. BMC Medicine, 13, 89. (Level 1 evidence)

U. S. Food and Drug Administration. (2013, November). Center for Devices and Radiologic Health. 510(k) Premarket Notification Database. K132741. Retrieved October 7, 2015 from http://www.fda.gov.

Webster, J., Liu, Z., Norman, G., Dumville, J.C., Chiverton, L., Scuffham, P., Stankiewicz, M., & Chaboyer, W.P. (2019). Cochrane Database of Systematic Reviews, doi: 10.1002/14651858.CD009261.pub4. Abstract retrieved July 15, 2019 from PubMed database.

Winifred S. Hayes, Inc. Medical Technology Directory. (2016, December; last update search December 2018). Negative pressure wound therapy for chronic wounds: home use. Retrieved July 15, 2019 from www.Hayes.com/subscribers. (75 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE: 11/18/2015

MOST RECENT REVIEW DATE:  8/8/2019         

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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