Question: I was told to submit the liposuction for lipedema procedure with CPT code 38999 (unlisted procedure, hemic or lymphatic system). Is that correct?
Using an unlisted code adds another level of complexity toward obtaining reimbursement. Unlisted codes are rarely reimbursed. It also reinforces the idea that the procedure is experimental and investigational–because there is no code for it! There are currently (2020) four liposuction CPT™ codes. They have no Medicare RVU’s (there is no Medicare fee schedule for them):
| 15876 | Suction assisted lipectomy; head and neck |
| 15877 | Suction assisted lipectomy; trunk |
| 15878 | Suction assisted lipectomy; upper extremity |
| 15879 | Suction assisted lipectomy; lower extremity |
Technically these codes only describe suction assisted lipectomy/liposuction, sometimes abbreviated as SAL. There are numerous different types (techniques/modalities) of liposuction. However, the AMA CPT™ codes make no distinction between liposuction modalities or techniques (lymph-sparing, tumescent, Water-Assisted (WAL™), Power-Assisted (PAL™), ultrasound, BodyJet™, CoolSculpting, micro-cannula, et. al.).
Not all techniques would be considered medically necessary or correct for lipedema. My recommendation is to avoid the specific brands/techniques because it might limit your choice of research study. If your procedure was specifically water-assisted but the majority of research does not address that technique, a carrier might use that detail to deny the claim. I believe the best term to describe the procedure for lipedema is Lymph-Sparing, Tumescent Liposuction. I abbreviate it LS-TL. That is not a commonly used medical abbreviation so you will always need to explain it if you plan to use it.
An argument could be made that a new code is necessary, not for technique but the condition. The new code would read: Lymph-Sparing, Tumescent Liposuction for lipedema. There is precedent in CPT™ codes in other fields for this:
92071: Fitting of contact lens for treatment of ocular surface disease
92072: Fitting of contact lens for management of keratoconus, initial fitting
The example above is particularly appropriate because a contact lens fitting for refraction is not a medical procedure and not reimbursed by any medical health insurance carrier. However, the two codes above are for a therapeutic purpose for a specific medical condition and are reimbursed by medical insurance carriers.
New codes must be requested by the professional associations and the individual surgeons, and they must lobby the American Medical Association to create a new code. This is process can take as long as five years. Often the AMA will introduce a category-three (CAT-III) CPT code (often called a “T” code because then end in a “T”) which is labeled as “investigational”, “experimental”, or temporary. Category III CPT codes have no RVU’s and are rarely paid. However I am aware of exceptions (based on extensive lobbying by interested parties).
My recommendation is to currently
use the existing four CPT codes for liposuction above and further explore the
need and interest for a specific reconstructive liposuction code for lipedema
with the relevant parties. [Mar 2020]. Even if all parties agreed it could be a
year or two before a new code was available.