{"id":128,"date":"2020-03-19T20:10:55","date_gmt":"2020-03-19T20:10:55","guid":{"rendered":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/?p=128"},"modified":"2020-03-19T20:10:55","modified_gmt":"2020-03-19T20:10:55","slug":"lymph-sparing-liposuction-marketing-ploy-or-medically-accurate-phrase","status":"publish","type":"post","link":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/lymph-sparing-liposuction-marketing-ploy-or-medically-accurate-phrase\/","title":{"rendered":"Lymph-Sparing Liposuction – Marketing Ploy or Medically Accurate Phrase?"},"content":{"rendered":"\n

Lymph-Sparing Liposuction – Marketing\nPloy or Medically Accurate Phrase?<\/strong><\/p>\n\n\n\n

Our\nmedical carrier reimbursement project for liposuction for lipedema is marketing\nsomething: that liposuction for lipedema is reconstructive and medically\nnecessary. Toward that goal we want the very best verbiage that helps us win\nthe most cases. I believe we need to differentiate reconstructive liposuction<\/em> from cosmetic\nliposuction<\/em>.<\/p>\n\n\n\n

It\nappears that Body Jet™, the WAL people have done a good job of making their\nproduct synonymous with “lymph-sparing” and liposuction for lipedema.\nSo, it terms of marketing, BodyJet has clearly marketed WAL and lymph-sparing\nas the only way to go.<\/p>\n\n\n\n

On the www.lipoforlipedemareimbursement.com<\/a> website I have elected to use the phrase Lymph-Sparing, Tumescent Liposuction<\/strong>, abbreviated to LS-TL. However I am not differentiating techniques (WAL, PAL, laser, Ultrasound). It has come to our attention that some liposuction experts consider lymph-sparing to be \u201cmarketing\u201d and that there is no difference in technique for lipedema\u2013it\u2019s the same whether it\u2019s for lipedema or cosmetic.<\/p>\n\n\n\n

In terms of just getting paid, the exact phrasing is not relevant\u2013as long as it gets the desired results. All I am doing is trying to get into the head of an insurance carrier review board, which is made up mostly of doctors, and make the best case why we should be reimbursed. If we have 100 carriers, my guess is that maybe 25% will appreciate how we address safety and the reconstructive aspect with the phrase \u201clymph-sparing\u201d\u2013and approve it; and there may be 5% that might assert that LS-TL requires a separate CPT code, and we would need to use an unlisted code; it\u2019s just harder to get paid but can be done.<\/p>\n\n\n\n

The more\ndata we gather, it becomes more apparent that we will always be working a fine\nline between differentiating cosmetic liposuction from reconstructive\nliposuction and the issue that reconstructive liposuction for lipedema should\nbe a new or unlisted CPT code. For the majority of healthcare carriers, just\ncalling it liposuction may well be enough. <\/p>\n\n\n\n

As a\nmuch longer-term strategy, the surgical associations and doctors should think\nabout whether a new reconstructive code is something you wish to pursue. I\ndon’t think the comparable procedures for cleft palate and breast\nreconstruction have their own codes but liposuction is different. Most\npatients, Providers, and insurance companies consider liposuction to be a\ncosmetic procedure. For that reason I want to emphasize it\u2019s unique usage in\nterms of lipedema.<\/p>\n\n\n\n

Ultimately\nthe way the patient will submit the claim documentation package and appeal package\nwill be based on how the doctor documents the liposuction from the beginning.<\/p>\n\n\n\n

If your surgeons does not use the\nphrase lymph-sparing anywhere in the surgical Operative Report or office notes\nI don\u2019t recommend adding it.<\/strong><\/p>\n\n\n\n

You may\nask before you begin the entire process if the doctor has been trained in the lymph-sparing\ntechnique (he\/she may not consider it any different than generic liposuction)\nand plans to document it as such.<\/p>\n\n\n\n

My guess\nis if the doctor uses WAL then they will, by habit, include the phrase “lymph-sparing”\nin their notes. If it’s PAL or another technique, and they were not trained by\nsomeone who emphasized lymph-sparing, then probably not.<\/p>\n\n\n\n

This is\na detailed and nuanced document. I’ve been working with doctors and helping\nthem document for administrative compliance and reimbursement for over 20\nyears. In many ways, it’s different than how they think clinically. We are\npreparing to battle with the healthcare insurance companies. Let\u2019s be prepared.\nBottom line: paid claims.<\/p>\n\n\n\n

Research<\/h4>\n\n\n\n

I found\nfour (4) research articles using the term, \u201clymph-sparing.\u201d Two are related to\nlipedema, one is for another condition and the Dr. Stutz article appears to be\nan internal journal from Body-Jet™.<\/p>\n\n\n\n

MON-116 Liposuction for Lipedema\n(Persistent Fat) in the US Improves Quality of Life <\/strong>(Cobos L et al, 2019) Lymph-sparing\nliposuction confirmed<\/p>\n\n\n\n

Reduction\nof lipedema fat is achieved effectively only by removal of fat by lymph-sparing liposuction<\/strong>. Women with lipedema noticed\nimproved ambulation after liposuction, likely due to removal of excess adipose\ntissue from the legs. Fat growth after liposuction was reported consistent with\npublished data. Improvement in quality of life after liposuction agrees with\nEuropean data, and greater perceived benefit in earlier stages emphasizes the\nimportance of early detection of lipedema and earlier intervention with\nliposuction. Prospective studies are needed to assess quality of life, fat\ngrowth, weight loss and ambulation after liposuction in women with lipedema in\nthe US.<\/p>\n\n\n\n

Prevention of Progression of\nLipedema With Liposuction Using Tumescent Local Anesthesia; Results of an\nInternational Consensus Conference <\/strong>(Sandhofer\nM et al, 2019) Confirmed lymph-sparing research long-term.<\/p>\n\n\n\n

Results:\nMultiple studies from Germany have reported long-term benefits for as long as 8\nyears after liposuction for lipedema using tumescent local anesthesia.<\/p>\n\n\n\n

Conclusion:\nLymph-sparing liposuction using tumescent local\nanesthesia<\/strong> is currently the only effective treatment for lipedema.\n[This is essentially my phrase here – Jeff]<\/p>\n\n\n\n

Zur Inzidenz lymphatischer\nKomplikationen nach varizenchirurgischen Eingriffen <\/strong>(Baier P et al 2018) This is not\nfor lipedema; but it does reference the phrase: lymph-sparing confirmed<\/p>\n\n\n\n

Conclusion\nLymph-sparing surgical techniques<\/strong> and\nanatomical\u2013topographical knowledge of the lymph supply are prerequisite for varicose vein surgery<\/strong>. In the cases of\nlymphatic complications, conservative measures should be exhausted before\nsurgical revision is performed.<\/p>\n\n\n\n

The\nprocedure is not liposuction and varicose veins, not lipedema, but the fact\nthat they use the phrase outside of the WAL influence indicates to me that\nlymph-sparing is a medically valid term – Jeff.<\/p>\n\n\n\n

Lymph-Sparing Liposuction for\nLipoedema – American-European Expert Meeting <\/strong>(Stutz J et al, 2014) References in the title lymph-sparing liposuction<\/strong> confirmed; this appears to be a\nBody-Jet™ publication.<\/p>\n\n\n\n

Here\u2019s a\nfifth research article related to lymphedema but not liposuction. The phrase \u201cLymph\nVessel Sparing Procedure\u201d is included.<\/p>\n\n\n\n

Fibro-Lipo-Lymph-Aspiration\nWith a Lymph Vessel Sparing Procedure<\/strong> to Treat\nAdvanced Lymphedema After Multiple Lymphatic-Venous Anastomoses: The Complete\nTreatment Protocol<\/p>\n\n\n\n

Scientific\nIRCCS Network Italian Ministry of Health<\/p>\n\n\n\n

Corrado\nCesare Campisi, Melissa Ryan, Francesco Boccardo, Corradino Campisi<\/p>\n\n\n\n

Liposuction doctors who include the\nphrase \u201clymph-sparing\u201d on their website:<\/strong><\/p>\n\n\n\n

  1. Thomas\nWright, MD; he has a very involved description of lymph-sparing.<\/li>
  2. Stefan\nRapprich; Lymph-Sparing Lipedema University; Youtube Video<\/li>
  3. Jamie\nS. Schwartz, description on website<\/li>
  4. Marcia\nByrd, MD, description on website<\/li>
  5. Josef\nStutz, MD (references it in his article)<\/li>
  6. Dr.\nDavid Greuner, surgical director of Roxbury Associates<\/li>
  7. Dr.\nDavid Amron, see reply below<\/li><\/ol>\n\n\n\n

    It\nappears that the seven leading liposuction for lipedema surgeons above are\n\u201cmarketing\u201d lymph-sparing. As far as I could tell, all of them use BodyJet™ or\nWater-Assisted Liposuction. So the influence by the vendor is real but the\nphrase appears to be medically valid as well. My impression is that the term\naddresses the uniqueness of liposuction for lipedema and a safety issue.<\/p>\n\n\n\n

    At the Fat\nDisorders Resource Society (FDRS) Annual Meeting, Dallas, TX, Dr. Wright<\/strong> gave a talk on Lymph-Sparing Liposuction Safety<\/em>. <\/p>\n\n\n\n

    \n
    The Principles of Lymph Sparing Liposuction<\/a><\/blockquote>