These are additional filing tips in addition to the Reimbursement Checklist. 0.1 Intro In general I have short, one or two-page checklists and then much longer and detailed explainations of nearly everything. Work the checklists first and then look to the Guidebook or the Policy Evaluation Document for more… Continue reading
Below is a valuable list of Gotchas!, Catch-22, Carrier-Specific Rules, and confusing, ambiguous, and contradictory Carrier guidelines and policies. This is kind of advanced but worth your time–especially if denied. I would argue it’s best to review before you file your claim. 1 WHAT IS A GOTCHA! ? A Gotcha… Continue reading
Q: Isn’t Lipedema the same as Obesity? No, it is a condition in which there is a pathological deposition of fatty tissue, usually below the waist, leading to progressive leg enlargement. Lipedema is often misdiagnosed as simply obesity or lymphedema. There is no cure for lipedema and it does not… Continue reading
Always get the background of the Expert Opinion Physician. Typically it will be a Plastic Surgeon. If the doctor is not a recognized name in liposuction for lipedema or lipedema diagnosis, work to determine their level of expertise. Expert opinion is not qualified. Propose that the expert is not a… Continue reading
Single Case Agreement (SCA) with Insurance Companies Making the case for single case agreement (SCA) with insurance companies Most cosmetic surgeons have chosen not to be a part of any insurance panel. Patients pay directly for services (out-of-pocket). Your insurance company may direct you to the nearest plastic surgeon assuming… Continue reading
The attached spreadsheet is for the patient to maintain all the information they need to be reimbursed. It is imperative that the patient has everything in order before they contact the insurance company for the pre-authorization. The more documentation you have, and the better it supports the procedure as reconstructive… Continue reading
Recommended updates to the lipedema.org coding page Aug 19 2020. https://www.lipedema.org/about-lipedema The information on the www.lipedema.org web page (Aug 19, 2020) is confusing and incorrect. Please see the update below. On June 12, 2020 an ICD-10-CM evaluation committee, headed by Dr. Karen Herbst with support from the American Vein and… Continue reading
Below is a sample letter to request a Reimbursement Policy Evaluation for Liposuction for Lipedema. While this example is Noridian Medicare, it can be used for any carrier. Just change the name and if they have any information in their manual I would add that as well. There are a… Continue reading
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
Lipedema and Lipolymphedema [Update September 9, 2020 Karen Herbst presented the new codes to the NCHS/CDC committee. The meeting went well and after a public review period it will be determined in early 2021 if they will move forward with the new codes.] Lipedema, initially described at the Mayo clinic… 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
I’ve been contacting researchers,surgeons, associations, and patients for months and providing up-to-date and accurate information on how to be reimbursed by insurance companies for liposuction for lipedema. The question I get most often is, “How can I help? What specifically do you want me to do?” So here is the… Continue reading
I am preparing a submission for the addition of specific lipedema codes for publication on Oct. 1 2021 to The National Center for Health Statistics (NCHS). Specific lipedema codes are needed for identification, tracking, and research. There are two due dates for feedback: June 12, 2020 and then September 2020…. Continue reading