Below I reviewed ten Experimental/Investigational (E/I/U) healthcare policies. The goal here is to compare and contrast them. While very similar, there are differences in the definitions, requirements, and restrictions. I have emphasized issues and terms I consider important. Remember my mottos: Words matter Specificity matters Dates matter Accuracy matters Tailoring… Continue reading
There are over 300 research studies regarding lipedema. There are over forty, peer-reviewed journal articles reviewing the benefits, efficacy, and safety of tumescent, lymph-sparing liposuction as the only surgical treatment for lipedema. For a lay person the most daunting task is knowing which research is considered most scientifically sound and… Continue reading
This term has different means depending on its usage. Many are inter-related. Clinical: It refers to whether treatment of a disease or condition is warranted medically. This is in regard to published Clinical Practice Guidelines (CPGs) for care for a particular condition. There are clinical guidelines for many conditions including… Continue reading
This is included more as a thought experiment. I don’t know if the “comparable procedure” argument would have any weight with an appeal review committee concerning reimbursement for liposuction for lipedema. I’ve never tried this strategy. However, if you’re working on your second or third-level appeal, it might be worth… Continue reading
[Clinicians, please feel free to add or make recommendations to this document. You can reach me using the contact form – Jeff]. The main point here is that a carrier will deny your claim if the patient is too sick for the procedure and their concerns are not addressed. This… Continue reading
This document is an adjunct to the Liposuction for Lipedema Overview; a lot of the information is the same except it is formatted differently and the slant here is to specifically address misperceptions, vague terms, and how precise language and consistency are important to win appeals. Or goal is to… Continue reading
Lipedema is a condition in which there is a pathological deposition of fatty tissue, usually below the waist, leading to progressive leg enlargement. There is no cure for lipedema and it does not respond well to diet and exercise. Incidence: Estimates of the incidence of lipedema range as high as… Continue reading
Education/Brief Overview of lipedema Lipedema is a condition in which there is a pathological deposition of fatty tissue, usually below the waist, leading to progressive leg enlargement. There is no cure for lipedema. Lipedema does not respond well to diet and exercise. It is the only available treatment for lipedema… Continue reading
Currently (MAR 2020), There is no ICD-10-CM diagnosis code in the United States specific to Lipedema. After reviewing this issue, I have identified three ICD-10-CM codes used in the USA for lipedema. Each one has its pros and cons. The three are: R60.9 Edema Q82.0 Familial Hereditary Edema E88.2: Adiposis… Continue reading
What CPT code should I submit for reconstructive liposuction? Continue reading
Updated Jan 22, 2021 While we don’t have more official payment policies for liposuction for lipedema we are getting more reports of payment. Aetna appears to be paying whereas Cigna (with an official denial policy) is difficult. Blue Shield of California may deny you several times and we have reports… Continue reading