CPT Codes for SnapshotNIR and the Importance of Documentation for Reimbursement
What are the CPT Codes for SnapshotNIR
Successful reimbursement has been observed in the WPS and First Coast regions for the following SnapshotNIR-related T-Codes: 0640T, 0641T, and 0642T. SnapshotNIR is an easy-to-use, cost-effective, and repeatable tool to assess and track the tissue oxygen level in a patient, whether at a wound site or in an area of vascular concern. Healing can be tracked and documented, with the image reports easily added to the patient record. These documented reports can be used to support medical necessity and proof of therapeutic efficacy for managed care reimbursement payments.
Suggested Documentation Guidelines
Documentation is critical in any profession, especially in the field of healthcare. Proper documentation is necessary to receive reimbursement from insurance payors. It is key for healthcare providers who bill for services provided to patients.
Medical necessity for any diagnostic procedure depends on one critical point: The provider must believe that the information obtained from the procedure could impact the course of treatment for the patient. An adequately documented clinical record enhances revenue cycle management. Patients get the care they desire, and the providers also get rewarded for services delivered. The following points may help to establish the validity of testing for your patients:
Indication for utilizing SnapshotNIR:
Why
Appropriate diagnosis coding (may include but are not limited to)
Graft/Flap
Wound/Ulcer
Underlying factors
PAD
Diabetes with microcirculatory manifestations
Vascular disease mixed etiology (arterial and/or venous)
Signs and Symptoms
Document any signs of compromised microcirculation/perfusion
Dusky color
Decreased temperature
Skin changes
Ulcer without improvement > two weeks
Reason for testing along with applicable underlying diagnosis (some examples listed below):
Assessment of micro-circulation, oxygenation, and or perfusion to wound and peri-wound or flap or graft site at the start of care and subsequent visits to document trends of healing or change the plan of care.
Assessment to determine the medical necessity for debridement and adequacy of debridement to take a chronic wound from the inflammatory stage back to the acute phase.
HBO Qualification or prospective evaluation to determine if HBO is effective or if the patient requires a vascular intervention.
To assess adequate wound bed preparation for advanced therapies such as cellular tissue products.
Assess the need for a vascular intervention.
Assess microcirculation for 4-6 weeks post-vascular reconstruction.
Oxygen challenge.
Where?
Describe in detail the anatomical location of the wound or flap, and number the sites if appropriate where the images were taken.
If this is a subsequent image on the same site, describe changes noted from previous images.
Include a description of peri-wound tissue.
Include other applicable site information (i.e., excessive edema, rubor, inflammation)
NOTE: when describing the characteristics of the site, other sections of the medical record may be referenced: “Image of L posterior lower extremity ulcer were obtained. A full description of this site may be found in the wound assessment portion of the patient record under “wound #1”.
If this is a subsequent image on the same site, describe changes noted from previous study(ies)
Include a description of peri-wound tissue
Include other applicable site information (i.e., excessive edema, rubor, inflammation)
NOTE: when describing the characteristics of the site, other sections of the medical record may be referenced: “Image of L posterior lower extremity ulcer were obtained. A full description of this site may be found in the wound assessment portion of the patient record under “wound #1”
Results:
Detail the results (image interpretation) for each site
Address areas of concern i.e., “lower left quadrant of the wound shows diminished microcirculation as evidenced by…”
Address areas of change if a subsequent image i.e., “significant improvement in microcirculation and oxygenation post 5 HBO treatments as evidenced by….”
How?
How will the results of testing impact your treatment plan? (see the following examples):
“We will send this patient for vascular consult. He/she may need surgical intervention based upon the diminished microcirculation noted in wound #1, which in my experience would not support wound healing…”
“We will begin a trial of HBO therapy for (diagnosis code), noting how the results of the imaging have shown diminished oxygenation/microcirculation, but an adequate response to an oxygen challenge examination with SnapshotNIR.”
“Graft is showing a decrease in oxygenation at 4 hours postoperatively. Will monitor for one hour, and if no improvement or worsening of the microcirculation will send to HBO for graft/flap salvage.”
Plan
What are the next steps? (The answers to the below questions may assist with this portion of the documentation.):
Will further images be planned post-intervention?
Will ongoing testing be indicated to monitor patient progress?
If frequent imaging is required, why?
Example: This graft will be reimaged Q2 hours for 24 hours to assure adequate perfusion/identify any change in perfusion
If you have further questions on reimbursement, read our FAQs page here.
If you’d like to speak to someone on our Kent Imaging Reimbursement Team, call our Toll-free Hotline 1-833-733-5368, or Email reimbursement@kentimaging.com
Information on coding, coverage, and payment systems is provided as a courtesy, but does not constitute a guarantee or warranty that payment will be provided. Kent Imaging encourages all customers to obtain (from the correct payer) current coding, payment system, coverage policies and regulations pertaining to the specific work she/he performs.