Lymph Activist's

LymphActivist's Site

Dedicated to Lymphedema Patients and the Therapists Who Treat Them

Q. Therapists are inquiring about billing Medicare. Supposedly, some of the billing codes have changed from what we have been offering. RN's, as well as Massage Therapists, also want to know how to bill. Might you have current information about billing codes?

A. ICD-10-CM will have a devastating effect on healthcare reimbursement, and will prove to create a "perfect storm" when it hits concurrently with the other changes such as reimbursement changes based on functional outcomes instead of services provided, personal insurance mandate, DMEPOS procurement and PQRS rewards/penalties. The healthcare situation will be very grim in the next few years.

But these issues are above my pay grade. So I concentrate on a small part of the problem—access to quality lymphedema care.

As currently structured the ICD-10-CM change will have little or no additional effect on lymphedema patients or therapists. There will be no additional diagnostic codes for lymphedema in ICD-10-CM than there are now in ICD-9-CM. There is a one-to-one mapping, and lymphedema providers need only use a cheat sheet to go from the existing codes they use to the new ones, which they will learn very quickly.

With respect to reimbursement for bandages and garments, the change in ICD-10-CM changes diagnostic codes only, and not HCPCS CPT or DMEPOS items. Compression materials for lymphedema remain non-covered.

CMS has not announced any changes yet to the reimbursement policies for therapy, but they will be coming. Right now the rules hold unchanged. To recap:

The person providing hands-on therapy must be a licensed PT or OT, or PTA or OTA under direct supervision of a PT or OT.
Service provided under a plan of care certified by a Medicare-enrolled physician or non-physician provider (NPP) (i.e. PA, NP, CNS) except for CORF services where NPPs may not order or certify therapy services.

There is, in my mind, a gray area with respect to provision of lymphedema therapy services by lymphedema-trained physicians or NPPs or RNs under their respective licenses as medical services (not rehabilitation).