{"id":69,"date":"2020-02-29T19:10:27","date_gmt":"2020-02-29T19:10:27","guid":{"rendered":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/?p=69"},"modified":"2020-02-29T21:24:50","modified_gmt":"2020-02-29T21:24:50","slug":"cpt-codes-for-liposuction-for-lipedema","status":"publish","type":"post","link":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/cpt-codes-for-liposuction-for-lipedema\/","title":{"rendered":"CPT codes for liposuction for lipedema"},"content":{"rendered":"\n

Question: I was told to submit the liposuction for lipedema procedure\nwith CPT code 38999 (unlisted procedure, hemic or lymphatic system). Is that\ncorrect?<\/strong><\/p>\n\n\n\n

Using an unlisted code adds\nanother level of complexity toward obtaining reimbursement. Unlisted codes are\nrarely reimbursed. It also reinforces the idea that the procedure is\nexperimental and investigational\u2013because there is no code for it! There are currently\n(2020) four liposuction CPT™ codes. They have no Medicare RVU\u2019s (there is\nno Medicare fee schedule for them):<\/p>\n\n\n\n

\n 15876\n <\/td>\n Suction assisted lipectomy; head and neck\n <\/td><\/tr>
\n 15877\n <\/td>\n Suction assisted lipectomy; trunk\n <\/td><\/tr>
\n 15878\n <\/td>\n Suction assisted lipectomy; upper extremity\n <\/td><\/tr>
\n 15879\n <\/td>\n Suction assisted lipectomy; lower extremity\n <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Technically these codes only\ndescribe suction assisted lipectomy\/liposuction, sometimes abbreviated as SAL.\nThere are numerous different types (techniques\/modalities) of liposuction. However,\nthe AMA CPT™ codes make no distinction between liposuction modalities or\ntechniques (lymph-sparing, tumescent, Water-Assisted (WAL™), Power-Assisted (PAL™),\nultrasound, BodyJet™, CoolSculpting, micro-cannula, et. al.).<\/p>\n\n\n\n

Not all techniques would be\nconsidered medically necessary or correct for lipedema. My recommendation is to\navoid the specific brands\/techniques because it might limit your choice of\nresearch study. If your procedure was specifically water-assisted but the\nmajority of research does not address that technique, a carrier might use that detail<\/em> to deny the claim. I believe\nthe best term to describe the procedure for lipedema is Lymph-Sparing,\nTumescent Liposuction. I abbreviate it LS-TL. That is not a commonly used medical\nabbreviation so you will always need to explain it if you plan to use it.<\/p>\n\n\n\n

An argument could be made\nthat a new code is necessary, not for technique but the condition. The new code\nwould read: Lymph-Sparing, Tumescent Liposuction for lipedema. There is\nprecedent in CPT™ codes in other fields for this:<\/p>\n\n\n\n

92071: Fitting of contact\nlens for treatment of ocular surface\ndisease<\/em><\/p>\n\n\n\n

92072: Fitting of contact\nlens for management of keratoconus,<\/em>\ninitial fitting<\/p>\n\n\n\n

The example above is\nparticularly appropriate because a contact lens fitting for refraction is not a\nmedical procedure and not reimbursed by any medical health insurance carrier.\nHowever, the two codes above are for a therapeutic purpose for a specific\nmedical condition and are <\/em>reimbursed\nby medical insurance carriers.<\/p>\n\n\n\n

New codes must be requested\nby the professional associations and the individual surgeons, and they must\nlobby the American Medical Association to create a new code. This is process can\ntake as long as five years. Often the AMA will introduce a category-three (CAT-III)\nCPT code (often called a \u201cT\u201d code because then end in a \u201cT\u201d) which is labeled\nas \u201cinvestigational\u201d, \u201cexperimental\u201d, or temporary. Category III CPT codes have\nno RVU\u2019s and are rarely paid. However I am aware of exceptions (based on\nextensive lobbying by interested parties).<\/p>\n\n\n\n

My recommendation is to currently\nuse the existing four CPT codes for liposuction above and further explore the\nneed and interest for a specific reconstructive liposuction code for lipedema\nwith the relevant parties. [Mar 2020]. Even if all parties agreed it could be a\nyear or two before a new code was available.
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What CPT code should I submit for reconstructive liposuction? Continue reading → <\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[55,33],"tags":[14,11,12,28,13,29,6,15,20,21,24,16,23,17,19,18,22,26,25,27],"class_list":["post-69","post","type-post","status-publish","format-standard","hentry","category-coding","category-reimbursement","tag-claim-form","tag-comorbidities","tag-cosmetic-surgery","tag-cpt-code","tag-experimental-investigative-or-unproven","tag-icd-10-code","tag-liposuction","tag-liposuction-reimbursed","tag-lymph-sparing","tag-medical-claim-form","tag-medical-insurance-companies","tag-medical-necessity","tag-medical-reimbursement","tag-plastic-surgeon","tag-power-assisted-liposuction-pal","tag-quality-of-life","tag-reconstructive-surgery","tag-reimbursement-policy","tag-restore-to-a-normal-appearance","tag-tumescent-liposuction"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts\/69","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/comments?post=69"}],"version-history":[{"count":2,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts\/69\/revisions"}],"predecessor-version":[{"id":88,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts\/69\/revisions\/88"}],"wp:attachment":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/media?parent=69"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/categories?post=69"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/tags?post=69"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}