{"id":76,"date":"2020-02-29T20:22:58","date_gmt":"2020-02-29T20:22:58","guid":{"rendered":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/?p=76"},"modified":"2020-02-29T20:22:58","modified_gmt":"2020-02-29T20:22:58","slug":"provider-patient-liposuction-for-lipedema-fact-sheet","status":"publish","type":"post","link":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/provider-patient-liposuction-for-lipedema-fact-sheet\/","title":{"rendered":"Provider \/ Patient Liposuction for Lipedema Fact Sheet"},"content":{"rendered":"\n

Lipedema<\/strong> is a condition in which there is a\npathological deposition of fatty tissue, usually below the waist, leading to\nprogressive leg enlargement. There is no cure for lipedema and it does not\nrespond well to diet and exercise.<\/p>\n\n\n\n

Incidence:<\/strong> Estimates of the incidence of lipedema range\nas high as 11% of the post-pubertal female population, which is approximately\n17 million women in the United States alone. Normal fat is 7%-23% for men and\n20% to 35% in women w\/ normal BMI. Lipedema is widely under and misdiagnosed as\nsimply obesity or lymphedema.<\/p>\n\n\n\n

Diagnosis:<\/strong> There are no diagnostic tests for lipedema;\ndifferential diagnosis is based on a physical exam and patient history.<\/p>\n\n\n\n

Reconstructive Liposuction: <\/strong>Care should be taken to refer to LS-TL for\nlipedema as reconstructive and never cosmetic. Avoid using terms such as\n\u201ccontouring\u201d, \u201cimprove appearance\u201d, \u201caesthetic\u201d or \u201ccosmetic liposuction\u201d in\nall Provider notes and pre-authorization letters. I recommend all plastic\nsurgeons to remove those terms (in regard to lipedema) from their website and\nany blogs. The medical (CPT™) term for liposuction is lipectomy.<\/p>\n\n\n\n

Reconstructive Surgery<\/strong> is performed on abnormal structures of the\nbody, caused by congenital defects, developmental abnormalities, trauma,\ninfection, tumors, or disease. It is generally performed to improve function,\nbut may also be done to approximate <\/em>a\nnormal appearance<\/em> (AMA and ASPS\ndefinition). The Medicare National Policy for reconstructive surgery requires\nthat the procedure be “reasonable\nand necessary<\/strong>\u2026for treatment of illness or injury or to improve the functioning<\/strong> of a malformed\nbody member<\/strong>.” [Reviewed MAR 2020].<\/p>\n\n\n\n

There are numerous different\ntypes<\/strong> (techniques\/modalities) of liposuction. Not all would be considered\nmedically necessary or correct for lipedema. However, the AMA CPT™ codes make no distinction between\nliposuction modalities or techniques (lymph-sparing, tumescent liposuction; WAL™; PAL™, ultrasound; BodyJet™; CoolSculpting™, et. al.).\nThere are four liposuction CPT™ codes; they are simply referred to as \u201csuction assisted lipectomy\u201d: 15876\n(head and neck), 15877 (trunk), 15878 (upper extremity), and 15879 (lower\nextremity). I would recommend using the phrase, Lymph-Sparing, Tumescent\nLiposuction (LS-TL) because it differentiates itself from cosmetic liposuction;\nlymph-sparing<\/em> refers to the specific\ntechnique used for removing lipedema fat; tumescent\n<\/em>refers to the injection of water and lidocaine into the removal site.<\/p>\n\n\n\n

Documentation:<\/strong> It is imperative that Providers use verbiage\nthat explains\/reinforces that liposuction for lipedema is uniquely a\nreconstructive surgery determined by medical necessity; all documentation\nshould follow the reconstructive guidelines above. Documentation must\ndemonstrate to the medical insurance company the patient has completed\nconservative non-surgical treatment of lipedema without adequate relief of\ntheir lipedema symptoms.<\/p>\n\n\n\n

Positive Outcomes<\/strong>: Research shows lymph-sparing liposuction yields good long term results in reduction of lipedema pain and in stopping the progression of lipedema. (Cornely et al., 2006; Schmeller et al., 2006; Warren et al., 2007; Rapprich et al., 2011, 2012).<\/p>\n\n\n\n

The need for conservative therapies such as Manual Lymphatic Drainage\n(MLD) and compression is greatly reduced in almost all patients, and in some\ncases, conservative therapies can be eliminated, after lymph sparing\nliposuction [Karen Herbst blog, 2014].<\/p>\n\n\n\n

Dangers of non-treatment<\/strong> Due to the development of secondary\nlymphedema and the irreversible damage to the lymphatic system that occurs in\nlater stages of the disease, liposuction should be implemented as part of the\nstandard therapy for lipedema at early stages. This will prevent disease\nprogression, improve quality of life, and reduce the need for decongestive\ntherapy.<\/p>\n\n\n\n

Carrier Liposuction Policy\nDenials<\/strong> (often) do not\naddress lipedema as a diagnosis. Tumescent liposuction is the only effective\ntreatment for an incurable disease of unknown etiology to reduced patient pain,\nimproved their quality of life, reduction of psychological stress, overall\nseverity score improved (Rapprich 2010) and prevent progression of the disease\nand expensive treatment.
<\/p>\n","protected":false},"excerpt":{"rendered":"

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 → <\/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":[33],"tags":[35,40,38,11,12,36,13,5,6,20,39,21,24,16,23,17,34,22,27],"class_list":["post-76","post","type-post","status-publish","format-standard","hentry","category-reimbursement","tag-appealing-a-denied-claim","tag-blue-cross-blue-shield","tag-claim-denial","tag-comorbidities","tag-cosmetic-surgery","tag-cosmetic-surgery-policy","tag-experimental-investigative-or-unproven","tag-lipedema","tag-liposuction","tag-lymph-sparing","tag-medicaid","tag-medical-claim-form","tag-medical-insurance-companies","tag-medical-necessity","tag-medical-reimbursement","tag-plastic-surgeon","tag-pre-authorization","tag-reconstructive-surgery","tag-tumescent-liposuction"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts\/76","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=76"}],"version-history":[{"count":1,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts\/76\/revisions"}],"predecessor-version":[{"id":77,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts\/76\/revisions\/77"}],"wp:attachment":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/media?parent=76"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/categories?post=76"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/tags?post=76"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}