CPT® Code 0640T

Official Description

Noncontact near-infrared spectroscopy (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), other than for screening for peripheral arterial disease, image acquisition, interpretation, and report; first anatomic site

Common Language Description

Noncontact near-infrared spectroscopy (NIRS) is a sophisticated imaging technique utilized primarily for the assessment of wounds, including diabetic ulcers, and the evaluation of skin flap oxygen perfusion. This method employs near-infrared light to measure the levels of deoxyhemoglobin and oxyhemoglobin in the tissue, thereby calculating the ratio of tissue oxygenation. The ability to differentiate between oxygenated and deoxygenated blood is crucial for predicting wound healing, assessing skin flap viability, and determining the success of biologic wound matrix applications. The principle behind NIRS is based on the relative transparency of tissue to near-infrared light, which reflects differently depending on the oxygenation status of the blood. A noncontact, hand-held imaging device, such as SnapshotNIR, is used to perform this assessment. The device is positioned over the area of interest, emitting six distinct near-infrared electromagnetic wavelengths of light that interact with hemoglobin molecules in the capillary bed. The light that is not absorbed is reflected back to the device, which records the data. Proprietary software then analyzes the return signal to assess the oxygen saturation levels at each pixel, producing a color-coded map alongside the clinical image. This comprehensive data is interpreted to generate a report detailing the healing progress or viability of the flap, as well as predicting the healing trajectory. Such information is invaluable in mitigating risks and enhancing patient outcomes. The CPT® code 0640T encompasses both the image acquisition and the interpretation and report for the first anatomic site evaluated, while code 0859T should be reported for each additional anatomic site assessed.

1. Indications

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

Wound Assessment This procedure is utilized to evaluate the oxygenation levels in wounds, such as diabetic ulcers, to determine their healing potential.
Skin Flap Viability NIRS is indicated for assessing the viability of skin flaps, ensuring that adequate blood flow and oxygenation are present for successful healing.
Monitoring Tissue Oxygenation The technique is employed to monitor tissue oxygenation levels, which is critical in predicting healing trajectories and outcomes.

2. Procedure

The noncontact near-infrared spectroscopy procedure involves several key steps to ensure accurate assessment and reporting. The following procedural steps are outlined:

Step 1: Device Preparation The noncontact hand-held imaging device, such as SnapshotNIR, is prepared for use. This includes ensuring that the device is calibrated and ready to emit the necessary near-infrared wavelengths.
Step 2: Positioning the Device The device is positioned over the area of interest, such as a wound or skin flap. Care is taken to ensure that the device is held at the appropriate distance to facilitate optimal light emission and reception.
Step 3: Emission of Near-Infrared Light The device emits six distinct near-infrared electromagnetic wavelengths of light. These wavelengths penetrate the tissue and interact with hemoglobin molecules, allowing for the differentiation between oxygenated and deoxygenated blood.
Step 4: Data Collection The light that is not absorbed by the tissue is reflected back to the device. The device records this return signal, capturing the data necessary for analysis.
Step 5: Data Analysis Proprietary calculation software analyzes the collected data, assessing the oxygen saturation levels at each pixel. This analysis results in a color-coded map that visually represents the oxygenation status of the tissue.
Step 6: Report Generation A comprehensive report is generated based on the interpreted data, detailing the healing progress or flap viability and predicting the healing trajectory. This report is crucial for clinical decision-making and patient management.

3. Post-Procedure

After the noncontact near-infrared spectroscopy procedure, the patient may not require any specific post-procedure care, as the procedure is noninvasive and does not typically result in discomfort. However, it is essential to review the generated report with the patient and discuss the findings. The clinician may use the information to make informed decisions regarding further treatment options, monitoring strategies, or interventions needed to enhance wound healing or skin flap viability. Regular follow-up assessments may be scheduled to monitor progress based on the initial findings from the NIRS procedure.

Short Descr	NCNTC IFR SPCTRSC O/T PAD 1
Medium Descr	NCNTC NR IFR SPECTRSC OTH/THN PAD 1ST ANTMC SITE
Long Descr	Noncontact near-infrared spectroscopy (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), other than for screening for peripheral arterial disease, image acquisition, interpretation, and report; first anatomic site
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	4 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic imaging 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	88 -
APC Status Indicator	Procedure or Service, Multiple Reduction Applies
Berenson-Eggers TOS (BETOS)	none
MUE	2

This is a primary code that can be used with these additional add-on codes.

0859T

Add On Code Resequenced Code MPFS Status: Carrier Priced APC N Noncontact near-infrared spectroscopy (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), other than for screening for peripheral arterial disease, image acquisition, interpretation, and report; each additional anatomic site (List separately in addition to code for primary procedure)

76	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.
GW	Service not related to the hospice patient's terminal condition
GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
LT	Left side (used to identify procedures performed on the left side of the body)
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
RT	Right side (used to identify procedures performed on the right side of the body)
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service