CAMPs LCD Updates
How you can use SnapshotNIR
in your clinical practice for CAMPs applications
“Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers”
Read the entire issue by CMS
"This Local Coverage Determination (LCD) has been developed to create a policy consistent with current evidence. The focus of this LCD is skin substitute grafts/cellular and tissue-based products (CTP) for the treatment of diabetic foot ulcers (DFU) and venous leg ulcers (VLU) in the Medicare population.”
“Skin substitute grafts/CTP are marketed as treatments for these ulcers. Coverage will be provided for skin substitute grafts/CTP having peer-reviewed, published evidence supporting their use as advanced treatment for chronic ulcers shown to have failed established methods to affect healing.”
improve your knowledge on vascular assessment methods for a comprehensive patient examination
support your clinical decision making with objective data on tissue viability with snapshotnir
understand how to use snapshotnir to support documentation for medical necessity camps use
direct and protect
The CAMPs LCD issue has impacted the use of near-infrared spectroscopy (NIRS) technology, including SnapshotNIR. These summaries can help direct patient care and protect your clinical decisions.
Vascular assessment
“Comprehensive patient assessment (history, exam, vascular assessment) and diagnostic tests indicated as part of the implemented treatment plan.”
LCD STATEMENT:
The MACs have recognized the need for alternatives to an ankle-brachial index (ABI) and which was replaced with “vascular assessment”. You can use SnapshotNIR as part of your complete patient vascular assessment.
The majority of MACs acknowledge NIRS as an option for vascular assessment, stating within their Response to Comments Articles:
“We agree that there are exceptions to ABI and the policy has been modified to allow alternatives to ABI including but not limited to NIRS. We agree with there may be situations in which alternative means to ABI may be clinical indicated.”
SnapshotNIR is a non-invasive vascular assessment that uses near-infrared light to identify the ratio of oxygenated to deoxygenated hemoglobin. This provides the medical professional with a low-cost measure of soft tissue oxygenation in a simple and consistent manner, at any care point.
THE DOWNFALLS OF ABI
SnapshotNIR can assist in providing a thorough, accurate vascular assessment. To see how your practice can be elevated by the use of SnapshotNIR, read this article comparing the methods.
Common limitations with ABI include:
Falsely elevated readings with medial artery calcification
Inability to take measurements on individuals with prior amputations
Time-consuming to complete
DIABETIC FOOT ULCER CASE SERIES
This case series is an example using SnapshotNIR for multiple diabetic foot ulcers prior to intervention, demonstrating the use of the device for assessing vascular integrity.
Vascular evaluation and patient monitoring
LCD STATEMENT:
“Vascular evaluation is also vital for all patients with DFU or VLU to demonstrate adequate perfusion for wound healing.”
Notably, ABIs cannot discern oxygenation - SnapshotNIR can.
The LCD states, “Palpation of pulses may be problematic in cases of medial arterial calcification and is not a reliable indicator of sufficient perfusion in diabetes. An objective, non-invasive measure of perfusion/oxygenation to determine if there is adequate flow for wound healing is helpful in predicting ulcer healing and/or the need for vascular intervention.”
PROOF OF WOUND IMPROVEMENT BEYOND STO2
The LCD states that an ‘unsuccessful’ application is when there is an increase in size or depth of an ulcer, no sign of significant improvement or indication that a significant improvement is likely.
When monitoring a wound for changes, improvements include granulation, epithelialization, progress towards closure.
SnapshotNIR can show you not only tissue oxygenation changes, but the hemoglobin trends that will indicate a wound is progressing towards epithelialization.
“The skin substitute graft/CTP is applied to an ulcer having failed to heal or stalled in response to documented SOC treatment.”
LCD STATEMENT:
Failure to heal has been aligned with current evidence to imply 50% ulcer size reduction. The LCD stated that documentation during the 4 weeks of SOC treatment is required, as well as documentation of measurements for the initial placement of the graft, and with every subsequent application.
WOUND SIZE AND MEASUREMENTS
SnapshotNIR can provide wound measurements, tissue oxygen saturation and hemoglobin trends to support the clinical decision that a wound healing has stalled, and that CAMPs application is a clinically-sound decision.
Linear and area measurements are key to tracking wound size changes and can be indicators if a wound is showing closure.
These features on SnapshotNIR can accurately and reliably help you monitor your patient’s wound size and support clinical decision making regarding wound healing potential.
medical necessity
LCD STATEMENT:
“The mean number of applications associated with complete wound healing is 4; however, with documentation of progression of wound closure under the current treatment plan and medical necessity for additional applications, up to 8 applications may be allowed.”
DOCUMENTATION MADE EASY WITH SNAPSHOTNIR
Showing progress with your CAMPs application can be done with SnapshotNIR. Photographic evidence of the wound improving in addition to the objective data collected regarding StO2, oxyhemoglobin and deoxyhemoglobin trends, helps provide support for the clinical decision to continue applications.
PHOTOGRAPHIC EVIDENCE
Graphic evidence of ulcer size, depth, and characteristics of the ulcer or photo documentation of the ulcer at baseline and follow-up with measurements of wound including size and depth should be part of the medical record, according to Noridian Healthcare Solutions (2021). This is supported by comments from the majority of MACs stating, “Supports best-practice medical documentation by including photographic evidence of wound size, depth, and characteristics at baseline and follow-up”.
SnapshotNIR can provide images of ulcer size and area, changes in StO2, and trends in hemoglobin levels.
LCD STATEMENT:
“The skin substitute graft/CTP must be used in an efficient manner utilizing the most appropriate size product available at the time of treatment. Excessive wastage (discarded amount) should be avoided by utilization of size appropriate packaging of the product consistent with wound size.”
To save resources and healthcare dollars related to CAMPs application, following a process is important. Using SnapshotNIR to guide clinical decisions can make a difference.
Monitoring the progress of CAMPs applications doesn’t need to be stressful. This case series shows the reapplications of a CAMP to heal a chronic wound on two patients.
QUESTIONS?
Email: reimbursement@kentimaging.com
Toll-free Hotline: 1-833-SEE-KENT (1-833-733-5368)
Jennie Feight, MS, CPC, CPMA, CPC-I
Senior Director of Health Policy
Disclaimer: The content of this website is not intended to guarantee coverage or payment for the use of SnapshotNIR. The existence of a coverage determination does not guarantee payment for the service it describes. Coverage and payment policies of governmental and private payers vary from time to time and for different areas of the country. Questions regarding coverage and payment by a payer should be directed to that payer. The only person responsible for a provider’s coding and documentation is the provider.