The Secrets to Optimal Lymphedema Reimbursement

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My name is Brandy McKeown and I am an occupational therapist certified in lymphedema and wounds. I have been a practicing lymphedema practitioner for the past 23 years. So I'm actually an occupational therapist by degree and within about a year of me practicing I got into the field of lymphedema and the rest is history from there.
 
So I am also, besides being a private practice practitioner, I own a couple of different lymphedema clinics, but I'm also the CEO of International Lymphedema and Wound Training Institute. So that is a training institute that does trainings throughout the United States, internationally we do those via tele-training and on-site. So that is a wonderful way for us to be able to reach as many practices as possible because we do those via tele-training as well. So I have wonderful passion for lymphedema and wounds so I think the two of them combine beautifully together and without applying compression to wounds oftentimes we don't see those heal anyway. So being able to add the two together it's just a beautiful merge and makes for some wonderful wound outcomes.
 
What are the guiding principles for getting optimal reimbursement for lymphedema?
 
One of the main pieces we see with lymphedema patients when we're trying to build and code and get reimbursement for lymphedema treatments is that oftentimes the diagnosis codes are not correct.
 
So when we're looking at lymphedema diagnosis, there's only three codes that are specifically for lymphedema. Those are I89.0, Q82.0, and I97.2. So I89.0 is Other lymphedema acquired, which means it's acquired, right? So that means we have to have a secondary diagnosis as well so that we can paint a better picture of why that person has lymphedema.
 
So, I think one of the biggest pieces we miss is not only do we not diagnose correctly, but then we don't give enough background to paint the picture of our patient with our diagnosis code. So I always say, you know, you can't just have an I89.0 because what caused that I89.0? What caused that lymphedema? So was it venous insufficiency? Were there wounds? Did the patient have cellulitis? Does a patient have really uncontrolled diabetes or did they have morbid obesity? All of those different codes can also be used to better paint a picture of the conditions that are really exacerbating that lymphedema and creating it.
 
So same thing happens with when we have wounds as well, we need to really work on painting that picture with that. So when we're looking at those ICD-10 codes, we really have to paint that picture of that patient, but then when we get into CPT codes, those procedural codes, what we actually do with those patients, we really have to stop and think that we don't just use those manual techniques. We have to be sure that we're incorporating some of the bandaging codes and some of the other procedural codes that we're using for therapeutic exercise and therapeutic activities such as being able to train our patients, how to don and doff a compression garment, all of those different pieces. So what we find is that if we're missing some of those other components and especially those bandaging codes, then we're not going to have very good reimbursement for our lymphedema treatment.
 
A lot of us as lymphedema practitioners were taught a long time ago that we bill almost everything under manual lymphatic drainage or MLD which is 97140 and what we know now is that yes, we're going to continue to build that when we're doing our manual techniques. However, when we're using our bandaging, there's other codes such as 29581 that we can use. We just have to make sure that we've painted that really good picture with those lymphedema ICD -10 codes in order to use that 29581. Because if we use lymphedema just as standalone, the 29581 is not going to go through. However, we're really painting that picture. with those patients, and we've got a lot of other diagnosis codes in there, then that 29581 is well substantiated with those diagnosis codes. As long as we're using also some of those modifiers, so such as the KS, XS, and also the, or the 59 Modifier with that, which makes it a distinct service when we're applying it with our 97140, or our therapeutic exercise, 97110.
 
What are the biggest reimbursement challenges for lymphedema?
 
Some of the biggest challenges by far is that there's not great CPT codes. There's not great procedural codes for lymphedema, right? So, unfortunately, as lymphedema therapists, we have to be pretty creative if we're gonna be financially viable in these programs and clinics. So we have to be a little more resourceful. We manual lymphatic drainage, all right, which is just manual therapy. It's not intended solely just for lymphedema. It's used in the therapy world quite frequently for other techniques as well. But we use that code.
 
The reimbursement for that is decent. It's okay. We add that the therapeutic exercise, therapeutic activities. They're all going to reimburse very similar to that 97140 as well. However, making sure that if we are doing the bandaging that we're using the 29581, we just have to make sure that we're putting the correct modifiers with that, we're making sure that we're having the multiple diagnosis codes with that so that we can substantiate it. And then what we find is that we can double our reimbursement almost in instantly by applying that code. So it went from being a very non-lucrative therapy, just with the use of manual therapy, to being a much more beneficial and lucrative coding system for these programs.
 
I always say, you know, lymphedema programs are never going to run if they're in the red. They have to be at least financially viable and substantiate and sustain themselves if we're going to have these programs alive all over the United States.
 
How can healthcare providers best overcome lymphedema reimbursement challenges?
 
We just have to make sure that we're really expanding our coding, expanding what we know and to explain what we're doing. So I always tell practitioners, you know, you know, you're doing that bandaging, that's the hard part, right? A lot of our patients also have wounds. And what I'm finding is that lymphedema practitioners are, they're not billing for any of the debridement type techniques for those wounds, right? So people forget that even when we're using a wound wash and a sterile gauze to clean that wound, that there's coating for that. There's things that we can do that are going to be financially beneficial when we're treating that patient, just so long as we're including everything.
 
Same thing with the 29581. Can we build manual therapy for that? Absolutely, we can. The difference in the reimbursement is over $50 for the difference in the reimbursement for the 29581 versus the 97140. So we have to be really, really careful with that. The other thing is that 29581, a lot of the time can also be done bilaterally. So we can't do that with manual therapy. If we've bandaged both legs, we can't use 97140 times two because those are timed codes. The 29581 is not a timed code. And so you can use a Modifier 50, still using the access or 59 modifier as a distinct service and we can actually apply both of those two of those codes to if we have bandaged both legs as well so very, very beneficial.
 
When we're treating arm patients you know we're still going to be able to utilize 29584 for bandaging of the arm just the just in the same way that we would use the 29581 with those leg patients.
 
So be resourceful, make sure that you're not stuck in the old realm of using 97140 for all of your lymphedema coding. And if you can really be resourceful and utilize those code sets that are best describing what we're actually doing to those patients, what we're gonna find is that we can be viable and profitable in our lymphedema treatments.
 
What will 2024 bring for lymphedema treatment and reimbursement?
 
One of the things that has happened in the last, just actually two days ago, the Lymphedema Treatment Act final rule was released. So we're going to find a lot more updates in the world of lymphedema coming in 2024.
 
So we know that goes into place in 2024. We're going to be able to get many more compression garments and proper compression garments for our patients that Medicare is now going to be able to reimburse and cover.
 
So I think that what we're going to see over the next year to two years in the realm of lymphedema is that things are going to improve for not only our patients but hopefully that will improve some of the focus on the therapists and the practitioners as well because now Medicare understands the importance of lymphedema for these patients to be able to provide those garments.
 
So hopefully we're going to get to see some better billing and coding procedures for lymphedema as well.