CPT® Code 0513T | Case2Code

Official Description

Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial woundeach additional wound (List separately in addition to code for primary procedure)

Common Language Description

Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment modality that utilizes high-energy acoustic waves to facilitate the healing of integumentary wounds. This procedure is particularly beneficial for chronic wounds, which may include venous leg ulcers, diabetic foot ulcers, pressure ulcers, and arterial insufficiency ulcers. Additionally, ESWT can be applied to acute conditions such as burns, postsurgical wounds, and post-traumatic wounds. The therapy involves the delivery of a sequence of biphasic acoustic pulses through a specialized transducer device. These pulses create transient pressure disturbances that propagate in a three-dimensional space, leading to a rise in pressure that stimulates neovascularization, reduces inflammation, and alleviates nociceptive pain. While ESWT is generally considered safe, potential complications may arise, including bleeding, petechiae, hematoma or seroma formation, and localized pain. The coding for this procedure is specific, with CPT® Code 0512T designated for the initial wound treatment, while CPT® Code 0513T is used to report each additional wound treated during the same session.

1. Indications

Extracorporeal shock wave therapy (ESWT) is indicated for the treatment of various chronic and acute integumentary wounds. The specific indications for this procedure include:

Chronic Wounds These may include venous leg ulcers, diabetic foot ulcers, pressure ulcers, and arterial insufficiency ulcers, which are often difficult to heal and require advanced therapeutic interventions.
Acute Conditions This includes burns, postsurgical wounds, and post-traumatic wounds, where rapid healing is essential to prevent complications and promote recovery.

2. Procedure

The procedure for extracorporeal shock wave therapy involves several key steps that ensure effective treatment of the wound. Each step is crucial for achieving optimal healing outcomes.

Step 1: Preparation of the Wound The initial step involves a thorough assessment of the wound to determine its type and severity. The area surrounding the wound is cleaned and prepared to ensure that the treatment can be applied effectively. This may include the removal of any necrotic tissue and the application of a topical anesthetic if necessary.
Step 2: Application of the Transducer A specialized transducer device is positioned over the wound site. This device is responsible for delivering the biphasic acoustic pulses. The clinician adjusts the settings on the transducer to ensure that the energy levels are appropriate for the specific type of wound being treated.
Step 3: Delivery of Shock Waves The transducer emits a series of high-energy acoustic pulses directed at the wound. These pulses create transient pressure disturbances that stimulate the healing process by promoting neovascularization and reducing inflammation. The duration and frequency of the treatment session may vary based on the wound's characteristics and the clinician's protocol.
Step 4: Post-Treatment Care After the application of shock waves, the clinician may apply a dressing to the wound to protect it and promote healing. Instructions for post-procedure care are provided to the patient, which may include guidelines on wound care and signs of potential complications to monitor.

3. Post-Procedure

Following the extracorporeal shock wave therapy, patients are typically advised on specific post-procedure care to optimize healing. This may include keeping the treated area clean and dry, changing dressings as instructed, and avoiding activities that could stress the wound. Patients should be monitored for any signs of complications, such as increased pain, swelling, or unusual discharge from the wound site. Follow-up appointments may be scheduled to assess the healing progress and determine if additional treatments are necessary.

Short Descr	ESW INTEG WND HLG EA ADDL
Medium Descr	ESW INTEGUMENTARY WOUND HEALING EA ADDL WOUND
Long Descr	Extracorporeal shock wave for integumentary wound healing, including topical application and dressing care; each additional wound (List separately in addition to code for primary procedure)
Status Code	Carriers Price the Code
Global Days	ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC)	0 - Physician Service 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 Packaged into APC Rates
ASC Payment Indicator	Packaged service/item; no separate payment made.
Berenson-Eggers TOS (BETOS)	none
MUE	2

This is an add-on code that must be used in conjunction with one of these primary codes.

0512T

Resequenced Code MPFS Status: Carrier Priced APC S ASC R2 Extracorporeal shock wave for integumentary wound healing, including topical application and dressing care; initial wound

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.
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure