Chronic Wound Management

Section: Therapy
Effective Date: July 01, 2018
Revised Date: August 09, 2019
Last Reviewed: July 16, 2019

Description

Electrical stimulation, also known as electrostimulation, refers to the application of electrical current through electrodes placed directly on the skin. Electromagnetic therapy involves the application of electromagnetic fields rather than direct electrical current. Both are proposed as treatments for wounds, generally chronic wounds.

Criteria

Electrical Stimulation

Electrical stimulation is covered for the management of the following types of chronic ulcers when it is used as adjunctive therapy after there are no measurable signs of healing for at least 30 days of treatment with conventional wound treatments (Electrical stimulation will not be covered as an initial treatment modality.):

  • Arterial ulcers
  • Diabetic ulcers
  • Pressure ulcers (Stage III or Stage IV)
  • Venous stasis ulcers

A course of electrical stimulation therapy for chronic ulcers would not typically be expected to exceed 60 minutes per day, or a total duration of more than one month.  Courses of electrical stimulation therapy for chronic ulcers exceeding 60 minutes per day are not considered medically necessary, as prolonged treatments beyond 60 minutes per day have not been proven to offer additional clinically significant benefits.

Continued treatment is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment. Measurable signs of improved healing include a decrease in wound size either in surface area or volume, decrease in amount of exudates, and decrease in amount of necrotic tissue. If electrical stimulation is being used, wounds must be evaluated at least monthly by the treating physician.

All other uses of electrical stimulation for the treatment of chronic ulcers will be denied as not medically necessary and, therefore, not covered.

Electrical stimulation for wound healing is not covered in the home setting, as unsupervised use by patients in the home has not been found to be medically necessary. Therefore, payment will not be made for an electrical stimulation device used to treat wounds.

Procedure Codes

E0769 G0281 G0282

Electromagnetic Therapy

Electromagnetic therapy is covered for the management of the following types of chronic ulcers when it is used as adjunctive therapy after there are no measurable signs of healing for at least 30 days of treatment with conventional wound treatments (Electromagnetic therapy will not be covered as an initial treatment modality.):

  • Arterial ulcers
  • Diabetic ulcers
  • Pressure ulcers (Stage III or Stage IV)
  • Venous stasis ulcers

Continued treatment is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment. Measurable signs of improved healing include a decrease in wound size either in surface area or volume, decrease in amount of exudates, and decrease in amount of necrotic tissue. If electromagnetic therapy is being used, wounds must be evaluated at least monthly by the treating physician.

All other uses of electromagnetic therapy for the treatment of chronic ulcers will be denied as not medically necessary and, therefore, not covered.

Electromagnetic therapy for wound healing is not covered in the home setting, as unsupervised use by patients in the home has not been found to be medically necessary. Therefore, payment will not be made for an electromagnetic wound treatment device used to treat wounds.

Electrical stimulation or electromagnetic therapy services that do not meet the medical necessity criteria on this policy will be considered not medically necessary.

It would not be appropriate for a patient to receive both electrical stimulation and electromagnetic therapy for the treatment of these wounds.

Procedure Codes

E0761 E0769 G0281 G0295 G0329

Noncontact Ultrasound Therapy

Noncontact ultrasound therapy for the treatment of chronic wound treatment is considered experimental/investigational. Scientific evidence does not support the effectiveness of this procedure.

Procedure Codes

97610

Diagnosis Codes

Covered Dx codes for procedure codes G0281 and G0329

E10.51 E10.52 E10.620 E10.621 E10.630 E10.638 E10.69
E11.51 E11.618 E11.620 E11.628 E11.630 E11.65 E11.69
E13.59 E13.618 E13.622 E13.628 E13.65 E13.69 I70.233
I70.234 I70.239 I70.241 I70.244 I70.245 I70.25 I70.261
I70.268 I70.269 I70.333 I70.334 I70.339 I70.341 I70.344
I70.345 I70.35 I70.431 I70.434 I70.435 I70.441 I70.442
I70.445 I70.448 I70.531 I70.532 I70.535 I70.538 I70.542
I70.543 I70.548 I70.549 I70.632 I70.633 I70.638 I70.639
I70.643 I70.644 I70.649 I70.65 I70.733 I70.734 I70.739
I70.741 I70.744 I70.745 I70.75 I83.001 I83.004 I83.005
I83.011 I83.012 I83.015 I83.018 I83.022 I83.023 I83.028
I83.029 I83.203 I83.204 I83.209 I83.211 I83.214 I83.215
I83.221 I83.222 I83.225 I83.228 I87.012 I87.013 I87.032
I87.033 I87.311 I87.312 I87.331 I87.332 I87.9 L89.003
L89.014 L89.023 L89.104 L89.113 L89.124 L89.133 L89.144
L89.153 L89.204 L89.213 L89.224 L89.303 L89.314 L89.323
L89.44 L89.500 L89.503 L89.504 L89.511 L89.512 L89.519
L89.520 L89.523 L89.524 L89.601 L89.602 L89.609 L89.610
L89.613 L89.614 L89.621 L89.622 L89.629 L89.810 L89.813
L89.814 L89.891 L89.892 L89.899 L89.93 L97.102 L97.103
L97.105 L97.106 L97.108 L97.111 L97.112 L97.115 L97.116
L97.118 L97.119 L97.121 L97.124 L97.125 L97.126 L97.128
L97.129 L97.203 L97.204 L97.205 L97.206 L97.208 L97.212
L97.213 L97.215 L97.216 L97.218 L97.221 L97.222 L97.225
L97.226 L97.228 L97.229 L97.301 L97.304 L97.305 L97.306
L97.308 L97.309 L97.313 L97.314 L97.315 L97.316 L97.318
L97.322 L97.323 L97.325 L97.326 L97.328 L97.401 L97.402
L97.405 L97.406 L97.408 L97.409 L97.411 L97.414 L97.415
L97.416 L97.418 L97.419 L97.423 L97.424 L97.425 L97.426
L97.428 L97.502 L97.503 L97.505 L97.506 L97.508 L97.511
L97.512 L97.515 L97.516 L97.518 L97.519 L97.521 L97.524
L97.525 L97.526 L97.528 L97.529 L97.803 L97.804 L97.805
L97.806 L97.808 L97.812 L97.813 L97.815 L97.816 L97.818
L97.821 L97.822 L97.825 L97.826 L97.828 L97.829 L97.901
L97.904 L97.905 L97.906 L97.908 L97.909 L97.913 L97.914
L97.915 L97.916 L97.918 L97.922 L97.923 L97.925 L97.926
L97.928 L98.411 L98.412 L98.415 L98.416 L98.418 L98.419
L98.421 L98.424 L98.425 L98.426 L98.428 L98.429 L98.493
L98.494 L98.495 L98.496 L98.498

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