CPT® Code 0642T

Code deleted, see 0640T, 0859T.

Official Description

Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); interpretation and report only, each flap or wound

Common Language Description

Noncontact near-infrared spectroscopy (NIRS) is a sophisticated imaging technique utilized for the assessment of wounds and skin flap oxygen perfusion through the application of light. This method is particularly valuable in measuring the levels of deoxyhemoglobin and oxyhemoglobin, as well as calculating the ratio of tissue oxygenation, known as StO2. These measurements are critical for predicting wound healing, evaluating the viability of skin flaps, and determining the success of biologic wound matrix applications. The principle behind NIRS lies in the fact that tissue is relatively transparent to near-infrared light, which allows the technique to differentiate between oxygenated and deoxygenated blood based on how the light is absorbed and reflected. A noncontact, handheld imaging device, such as SnapshotNIR, is employed to measure the oxygenation levels within the capillary bed. This device is positioned over the area of interest, emitting six different near-infrared electromagnetic wavelengths of light. Each wavelength interacts differently with oxygenated and deoxygenated hemoglobin molecules, resulting in varying absorption levels. The light that is not absorbed is reflected back to the device, which records this information. The proprietary software integrated into the device processes the return signal to assess the oxygen saturation levels at each pixel, ultimately generating a color-coded map that visually represents the oxygenation status alongside the clinical image. The interpretation of this data culminates in a comprehensive report detailing the healing progress or viability of the flap, as well as predicting the healing trajectory. This information is instrumental in mitigating risks associated with wound healing and enhancing patient outcomes. It is important to note that while code 0640T encompasses both the image acquisition and the interpretation and report for each flap or wound study, code 0641T pertains solely to image acquisition, whereas code 0642T is designated for the interpretation and report only.

1. Indications

The noncontact near-infrared spectroscopy studies are indicated for the assessment of various conditions related to wound healing and skin flap viability. The following are the specific indications for which this procedure is performed:

Wound Assessment This procedure is utilized to evaluate the oxygenation status of wounds, which is critical for determining the healing potential and necessary interventions.
Skin Flap Viability It is employed to assess the viability of skin flaps, ensuring that adequate blood flow and oxygenation are present for successful healing.
Monitoring Healing Progress The technique is used to monitor the healing progress of wounds and flaps over time, providing valuable data to guide treatment decisions.
Predicting Healing Trajectory The information obtained from NIRS can help predict the trajectory of healing, allowing for proactive management of potential complications.

2. Procedure

The procedure for noncontact near-infrared spectroscopy studies involves several key steps that ensure accurate assessment and reporting of the flap or wound condition. The following procedural steps are outlined:

Step 1: Device Preparation The handheld imaging device, such as SnapshotNIR, is prepared for use. This includes ensuring that the device is charged and calibrated according to the manufacturer's specifications to guarantee accurate readings.
Step 2: Positioning the Device The device is positioned over the area of interest, which may be a wound or a skin flap. Care is taken to ensure that the device is held at the appropriate distance and angle to optimize the capture of data.
Step 3: Emission of Near-Infrared Light The device emits six different near-infrared electromagnetic wavelengths of light. These wavelengths penetrate the tissue and interact with the hemoglobin present in the blood, allowing for the differentiation between oxygenated and deoxygenated blood.
Step 4: Data Capture The light that is not absorbed by the tissue is reflected back to the device. The device captures this reflected light and records the data for analysis.
Step 5: Data Analysis The proprietary software within the device processes the captured data, assessing the oxygen saturation levels at each pixel. This analysis results in a detailed color-coded map that visually represents the oxygenation status of the tissue.
Step 6: Interpretation and Reporting The final step involves interpreting the data and generating a comprehensive report. This report includes information on the healing progress, flap viability, and predictions regarding the healing trajectory, which can be utilized for clinical decision-making.

3. Post-Procedure

After the noncontact near-infrared spectroscopy study is completed, the following post-procedure considerations are important to ensure optimal patient care and follow-up:

Patients may be advised on the interpretation of the results, which will guide further treatment options. The report generated from the procedure should be reviewed in conjunction with other clinical findings to develop a comprehensive care plan. Additionally, ongoing monitoring of the wound or flap may be necessary, depending on the findings of the NIRS study. This may include regular follow-up assessments to track healing progress and make timely adjustments to treatment as needed. It is essential to communicate any significant findings from the report to the patient and relevant healthcare team members to ensure coordinated care and optimal outcomes.

Short Descr	NCNTC NR IFR SPCTRSC WND I&R
Medium Descr	NCNTC NR IFR SPECTRSC FLAP/WND I&R ONLY
Long Descr	Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); interpretation and report only, each flap or wound
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	2 - Professional Component Only Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Not Billable to the MAC
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.

Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.

Service not related to the hospice patient's terminal condition