Archived Policies - DME


Noncontact Normothermic Wound Therapy

Number:DME101.044

Effective Date:07-01-2004

End Date:09-30-2006

Coverage:

The use of noncontact normothermic wound therapy (NNWT), either as a primary intervention or as an adjunct to other wound therapies, is considered experimental or investigational.

Description:

An optimal environment for wound healing is thought to include a moist normothermic environment enhancing the subcutaneous oxygen tension and increasing the blood flow to the wound.  A device, called Warm-Up Active Wound Therapy©, approved by the United States Food and Drug Administration (FDA), attempts to create this environment.  Contents include a noncontact badge and a warming unit designed to maintain 100% relative humidity, producing a normothermia in the wound and surrounding tissues.  The bandage is composed of a sterile foam collar that adheres to the periwound skin and a sterile, transparent film covering the top of the wound, without making contact.  An infrared warming card is inserted into a pocket of the film covering.  Treatments are administered 3 times a day in 1 hour increments.

Rationale:

Normal components of wound therapy include:

  • Sharp debridement of devitalized tissue;
  • Infection control;
  • Non-weight bearing; and
  • Treatment of underlying comorbidities.

Therefore, substantiation of any adjunct to standard wound management requires a randomized controlled trial to isolate the contribution of the intervention compared to underlying wound management.

A review of literature identified a small study; Santilli and colleagues, evaluated venous stasis ulcers, failing conventional wound care therapies.  A total number of 17 patients with 31 wounds served as the studies control group.  The study reported improvement in 14 out of the 17 patients during the 2 week trial.  Another study, Kloth and colleagues evaluated 40 hospitalized patients; with 43 Stage III and IV pressure ulcers; the control group of 22 wounds was treated with moisture retentive dressings 24 hours a day, 7 days a week, for 12 weeks or until wound closure. The NNWT category of wounds utilized 21 wounds with a sterile noncontact wound dressing applied to 21 wounds for 24 hours each day, 7 days a week.  With daily wound irrigation, a new noncontact dressing was applied and the heating element in the dressing activated for 1 hour intervals, 3 times a day.

For the NNWT group, results revealed a healing rate of 0.52 cm2 per week and the control group 0.23 cm2 per week.   While studies of wound healing therapies commonly use patients as their own control, this type of trial design cannot determine the contribution of NNWT with wound care.

Contract:

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coding:

None


Medicare Coverage:

None

References:

Santilli, S., and Valusek, P., et al. Use of a noncontact radiant heat bandage for the treatment of chronic venous statis ulcers. Advance Wound Care (1999 March) 12(2): 89-93.

Noncontact Radiant Heat Bandage for the Treatment of Wounds. BCBSA Consortium Health Plan Medical policy Reference Manual (2002 April 15) Medicine: 2.01.41.

Kloth, L., and Berman, J., et al. A randomized controlled clinical trial to evaluate the effects of noncontact normothermic wound therapy on chronic full-thickness pressure ulcers. Advance Skin and Wound Care (2002 November-December) 15(6): 270-276.

Policy History:

Archived Document(s):

Title:Effective Date:End Date:
Ultrasound Wound Therapy07-01-201804-14-2019
Ultrasound Wound Therapy06-15-201706-30-2018
Ultrasound Wound Therapy07-01-201606-14-2017
Noncontact Wound Therapy07-01-201506-30-2016
Noncontact Wound Therapy11-01-201406-30-2015
Noncontact Wound Therapy04-15-201210-31-2014
Noncontact Wound Therapy04-01-201004-14-2012
Noncontact Wound Therapy01-01-200803-31-2010
Noncontact Normothermic Wound Therapy10-01-200612-31-2007
Noncontact Normothermic Wound Therapy07-01-200409-30-2006
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