lymphedema - peninsula professional coderspeninsulaprofessionalcoders.com/pdf/lymphedema.pdf ·...
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LYMPHEDEMA
Presented by Katrin Gardarsdottir, LPTA, Cert.CDT
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PERSONAL BIO
• Graduated from Tidewater Community College in 2001 with Associates
Degree in Applied Science, Physical Therapy Assistant Major
• Began working at Tidewater Physical Therapy, Inc. June of 2001 to present
• Earned my Certificate from the Academy of Lymphatic Studies as a
Decongestive Therapist in Sept of 2002.
• Certified compression garment fitter for Juzo, Jobst, and Circaid
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LYMPHATIC SYSTEM
• It is a one way system that carries lymphatic fluid from the interstitial tissues to the
circulatory system
• Removes impurities from the body
• Returns excess water, protein molecules, and large molecules to the venous system
• Contains lymphnodes whose functions include
• Stimulation of the immune response
• Production of antibodies and lymphocytes
• Filters out tissue debris and foreign materials
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LYMPHEDEMA
DEFINITION
Lymphedema occurs when
the lymph load exceeds the
transport capacity causing an
accumulation of fluid and
protein in the tissue spaces.
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WHAT IS LYMPHEDEMA
• An incurable, but treatable condition
• A swelling of a body part(s), most often an extremity
• An abnormal accumulation of protein rich fluid in the tissue spaces
• Caused by a malfunction or disruption of any component of the system
• Increasing in incidence due to lifesaving caner treatments
• Usually progressive
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PRIMARY
LYMPHEDEMA
• Congenital condition caused by
a malformation of the
Lymphatic System
• Lymphnodes can be Hypoplasic,
Hyperplasic, or Aplasic
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SECONDARY
LYMPHEDEMA
• Caused by an insult to the Lymphatic
System
• Dissection of Lymphnodes
• Radiation
• Surgery
• Trauma
• Frequent Infections
• Chronic Venous Insufficiencies
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SIGNS & SYMPTOMS
• Heavy or full feeling in the limb
• Sleeves or pant legs may feel tight
• Rings, bracelets, or watches may feel tighter than before
• Swelling
• Decreased flexibility or range of motion in joints due to swelling
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COMPLICATIONS OF LYMPHEDEMA
• Pain
• Weakness
• Decreased ROM
• Decreased function
• Decreased immune system function
• Wounds
• Decreased wound healing
• Fungal infections
• Cellulitis
• Fibrotic tissue
• Lymph cysts or blisters
• Lymphorrhea
• Lobules and papilloma’s
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COMPONENTS OF TREATMENT
• Manual Lymph Drainage (MLD)
• Compression Bandaging
• Compression Garments
• Daytime Compression Garments
• Night Time Compression Garment
• Patient Education
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MANUAL LYMPH
DRAINAGE
Manual Technique that redirects
the flow of lymphatic fluid from a
congested area to an non congested
area where it can be filtered and
processed.
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COMPRESSION
WRAPPING
Compression wraps are used during treatment to:
Prevent refilling of the limb between
treatments
Improve the muscle joint pump during activity
Supports tissues that have lost their elasticity
Breaks up fibrotic tissue
Increased tissue pressure improved
lymphatic and venous return
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COMPRESSION GARMENTS
• Four different strengths ranging from 20mmHg to 60mmHg.
• Designed to hold the limb at the current size, they are not
designed to reduce the size of the limb
• Contraindicated to fit a swollen limb with compression garments
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DAYTIME COMPRESSION GARMENTS
CIRCULAR KNIT GARMENT FLAT KNIT GARMENT
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NIGHT TIME COMPRESSION GARMENT
REID SLEEVE CIRCAID
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PATIENT EDUCATION
• Precautions
• Skin care
• Infection prevention and signs & symptoms
• Home management techniques
• Self Manual Lymph Drainage
• Self Bandaging
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DIAGNOSIS CODES
• 457.0 Lymphedema
• 457.1 Post Mastectomy Lymphedema Syndrome
• 457.1 Secondary Lymphedema
• 757.0 Congenital Lymphedema
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TREATMENT CODES
• CPT 97001 Initial Evaluation
• CPT 97110 Therapeutic Exercises
• CPT 97530 Therapeutic Activities
• CPT 97140 Manual Therapy
• CPT 97750 Physical Performance Test
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DME CODES UPPER EXTREMITY
• HCPC L8010 Compression Sleeve
• HCPC L8010A Compression Sleeve with Glove
• HCPC L8010B Compression Sleeve with Gauntlet
• HCPC L3999D Compression Bra
• HCPC A6549A Compression Glove only
• HCPC A6549B Compression Gauntlet only
• HCPC A4465A Upper Extremity Night Device
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DME CODES LOWER EXTREMITY
• HCPC A6530 Knee High Compression Hose, 20-30mmHg, Each Item
• HCPC A6531 Knee High Compression Hose, 30-40mmHg, Each Item
• HCPC A6532 Knee High Compression Hose, 40-50mmHg, Each Item
• HCPC A6533 Thigh High Compression Hose, 20-30mmHg, Each Item
• HCPC A6534 Thigh High Compression Hose, 30-40mmHg, Each Item
• HCPC A6535 Thigh High Compression Hose, 40-50mmHg, Each Item
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DME CODES LOWER EXTREMITY
• HCPC A6539 Pantyhose Style Compression Hose, 18-30mmHg
• HCPC A6540 Pantyhose Style Compression Hose, 30-40mmHg
• HCPC A6541 Pantyhose Style Compression Hose, 40-50mmHg
• HCPC A6549 Custom Compression Garments both upper and lower
extremity
• HCPC A4465B Lower Extremity Night Device
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BANDAGES
• HCPC A6441 Padding Bandage, eg Artiflex 3 units = 1 roll
• HCPC A6450 Light Compression Bandage, eg Idealbind 5 units = 1 roll
• HCPC A6451 Moderate Compression Bandage, eg Rosidal 5 units = 1 roll
• HCPC A6452 High Compression Bandage, eg Dauerbinde 7 units = 1 roll
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BILLING
• Must have a prescription
• Letter of medical necessity
• Proof of delivery
• Advance Beneficiary Notice (ABN)
• Modifiers
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CONTACT INFORMATION
Katrin Gardarsdottir, LPTA, Cert CDT
Tidewater Physical Therapy
12655 Warwick Blvd Ste B
Newport News, VA 23606
Phone 757-599-5551
Fax 757-595-5238