Electrostimulation and Electromagnetic Therapy for the Treatment of Chronic Wounds
© Blue Cross and Blue Shield of Montana
Current Effective Date:
August 27, 2013
Original Effective Date:
November 01, 2010
August 27, 2013
December 5, 2012; June 28, 2013
Electrical stimulation refers to the application of electrical current through electrodes placed directly on the skin in close proximity to the wound. Electromagnetic therapy involves the application of electromagnetic fields rather than direct electrical current. Both are proposed as treatments for chronic wounds.
The normal wound healing process involves inflammatory, proliferative, and remodeling phases. When the healing process fails to progress properly and the wound persists for longer than 1 month, it may be described as a chronic wound. The types of chronic wounds most frequently addressed in studies of electrical stimulation for wound healing are 1) pressure ulcers, 2) venous ulcers, 3) arterial ulcers, and 4) diabetic ulcers. Conventional or standard therapy for chronic wounds involves local wound care, as well as systemic measures including debridement of necrotic tissues, wound cleansing, and dressing that promotes a moist wound environment, antibiotics to control infection, and optimizing nutritional supplementation. Non-weight bearing is another important component of wound management.
Since the 1950s, investigators have used electrical stimulation as a technique to promote wound healing, based on the theory that electrical stimulation may:
- Increase adenosine triphosphate (ATP) concentration in the skin,
- Increase deoxyribonucleic acid (DNA) synthesis,
- Attract epithelial cells and fibroblasts to wound sites,
- Accelerate the recovery of damaged neural tissue,
- Reduce edema,
- Increase blood flow, and/or
- Inhibit pathogenesis.
Electrical stimulation refers to the application of electrical current through electrodes placed directly on the skin in close proximity to the wound. The types of electrical stimulation and devices can be categorized into four groups based on the type of current:
- Low-intensity direct current (LIDC),
- High-voltage pulsed current (HVPC),
- Alternative current (AC), and
- Transcutaneous electrical nerve stimulation (TENS).
Electromagnetic therapy is a related but distinct form of treatment that involves the application of electromagnetic fields rather than direct electrical current.
No electrical stimulation or electromagnetic therapy devices have received approval from the U.S. Food and Drug Administration (FDA), specifically for the treatment of wound healing. A number of devices have been cleared for marketing for other indications. Use of these devices for wound healing is an off-label indication.
Refer to the ICD-9-CM manual.
E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622, E13.621, E13.622, I83.001-I83.029; I83.201-I83.229, L00-L08.9, L89.00-L89.95, L97.10-L97.929, L98.41-L98.499, L99
64550, A4556, A4557, A4595, A4630, E0720, E0730, E0745, E0761, E0769, G0281, G0282, G0295, G0329
- Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Electrical stimulation or electromagnetic therapy as adjunctive treatments for chronic skin wounds. TEC Assessments 2005; Volume 20, Tab 2.
- Medicare Technology Assessments for Electrostimulation for Wounds (CAG-00068N). Available online at: http://www.cms.hhs.gov. Last accessed July, 2011.
- Game FL, Hinchliffe RJ, Apelqvist J et al. A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2012; 28 Suppl 1:119-41.
- Aziz Z, Cullum NA, Flemming K. Electromagnetic therapy for treating venous leg ulcers. Cochrane Database Syst Rev 2011; (3):CD002933.
- Aziz Z, Flemming K, Cullum NA et al. Electromagnetic therapy for treating pressure ulcers. Cochrane Database Syst Rev 2010; (11):CD002930.
- Adunsky A, Ohry A, Ddct G. Decubitus direct current treatment (DDCT) of pressure ulcers: results of a randomized double-blinded placebo controlled study. Arch Gerontol Geriatr 2005; 41(3):261-9.
- Houghton PE, Campbell KE, Fraser CH et al. Electrical stimulation therapy increases rate of healing of pressure ulcers in community-dwelling people with spinal cord injury. Arch Phys Med Rehabil 2010; 91(5):669-78.
- Franek A, Kostur R, Polak A et al. Using high-voltage electrical stimulation in the treatment of recalcitrant pressure ulcers: results of a randomized, controlled clinical study. Ostomy Wound Manage 2012; 58(3):30-44.
- Gupta A, Taly AB, Srivastava A et al. Efficacy of pulsed electromagnetic field therapy in healing of pressure ulcers: a randomized control trial. Neurol India 2009; 57(5):622-26.
- Association for the Advancement of Wound Care (AAWC). Association for the Advancement of Wound Care guideline of pressure ulcer guidelines. Available online at: www.guideline.gov. Last accessed September, 2011.
- Electrostimulation and Electromagnetic Therapy for the Treatment of Chronic Wounds. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (October 2012) Medicine 2.01.57.
||Policy updated with literature review; policy statements unchanged. References 3 and 8 added; other references renumbered or removed. |
||Policy formatting and language revised. Policy statement unchanged. Added codes 64550, A4556, A4557, A4595, A4630, E0720, E0730, E0745, E0761. Title changed from "Electrostimulation and Electromagnetic Therapy for the Treatment of Wounds" to "Electrostimulation and Electromagnetic Therapy for the Treatment of Chronic Wounds".|