Lymph-Sparing Liposuction – Marketing Ploy or Medically Accurate Phrase? Our medical carrier reimbursement project for liposuction for lipedema is marketing something: that liposuction for lipedema is reconstructive and medically necessary. Toward that goal we want the very best verbiage that helps us win the most cases. I believe we need… 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
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