Yes, this is the same Guidebook that is on Amazon.com. It is provided here at no cost to you and in .DOC format so you can copy-and-paste any of into your pre-authorization or appeal document. I am updating it every 4-6 weeks. My goal is to update this document every… Continue reading
FOR IMMEDIATE RELEASE June is National Lipedema Awareness Month Memphis TN, June 12, 2020 Lipedema is often misdiagnosed as obesity, edema, or lymphedema. While all can be present with lipedema, it is a separate condition. When lymphedema occurs with lipedema it’s known as lipolymphedema, a secondary lymphedema. To accurately diagnose… Continue reading
The information below would be of most interest to those performing liposuction for lipedema, and in particular those who are interested in obtaining carrier reimbursement for the procedure. Please see my other posts concerning reconstructive versus cosmetic and medical necessity for coverage of those important reimbursement issues. The information below… Continue reading
After several months feedback has been to simplify, simply, and SIMPLIFY! I’ve updated the checklist (Aug 14, 2020). I now have a one-page concise version plus a longer, three-page version. The guidebook will be updated shortly in Aug 2020 and is now over 50 pages. While personally I think all… Continue reading
I encourage all doctors and associations to add, at the very least, the following single sentence to their website or blog (patients please share this with everyone who cares as well as your doctor; it can make the difference between reimbursement and a denial): There are two kinds of liposuction:… Continue reading
Below is a list of terms, phrasing and supporting research you can include in your pre-authorization or appeal documentation package as appropriate: Medically effective FDA approved equipment Conclusions…the effect of the intervention on health outcomes Make argument …that measurement(s) or alteration affects health outcomes Safe or effective Exceeding the outcome… Continue reading
The most recent Excel version of the checklist is above. 1 Liposuction for Lipedema Reimbursement CHECKLIST. Asterisk * [right] means additional information is available on www.lipoforlipedemareimbursement.com [December 2, 2020] Check website for updates.2 Make a decision for surgery (in the future). [Website www.lipoforlipedemareimbursement.com]3 Review your insurance policy for coverage information…. Continue reading
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
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
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
What CPT code should I submit for reconstructive liposuction? Continue reading