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1 Sillerman Center for Rehabilitation The presenters have no conflict of interest to report regarding any commercial product/manufacturer that may be referenced during this presentation. 1

2 Key components in setting up a Lymphedema Clinic - Clinical staff - Floor plan layout - Equipment/supplies - Documentation - Support staff - Scheduling - Insurance considerations - Marketing 2

3 Private rooms v. curtained bays Level of privacy Privacy curtains Millwork for storage 3

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11 Documentation CPT Codes Manual therapy. Joint mobilizations, manual traction, passive range of motion, manual lymphatic drainage, decongestive therapy, myofascial release, and soft tissue mobilization. Manual lymphatic drainage includes the application of compression bandaging Therapeutic exercise. Develop strength, endurance, range of motion (ROM), and flexibility. It can include active, active-assisted, and passive exercises Self care/home management training. Activities of daily living (ADL), meal preparation, safety procedures, and instruction in the use of adaptive equipment. Documentation CPT Codes Vasopneumatic devices. These devices are used to reduce edema in an extremity or to treat lymphedema. Patient education in the use of a lymphedema pump would be included in this code. Many insurance companies and Medicare contractors allow two to four treatments of this. Additional treatments may be reimbursed if documentation supports medical necessity of the intervention and why it requires the unique skills of a PT or OT Non-selective debridement, without anesthesia. This code includes wet-to dry/moist dressings and debridement by enzymatic application and abrasion. This code is also untimed and is not reimbursed by Medicare. Dressing supplies or time spent performing dressing changes should not be billed separately as they are included in the reimbursement amount. Documentation CPT Codes Removal of devitalized tissue from wounds. Includes selective debridement without anesthesia (e.g., high pressure waterjet with or without suction, sharp selective debridement with scissors, scalpel, and forceps), with or without topical applications, wound assessment, and instruction for ongoing care. May include the use of a whirlpool. Bill for this per session when the total wound surface area is equal to or less than 20 sq cm same as above except bill this code when the total wound surface area is greater than 20 sq cm. Tip: When you are dealing with more than one wound for codes or 97598, add up the total wound surface of all the wounds. 11

12 G-Codes Other PT/OT Primary Functional Limitation Lymphedema Wound care Other PT/OT Subsequent Functional Limitation it ti Select only after Primary Fxn l Limitation has been reported Severity Modifiers (7 point scale) CH : 0% impaired, limited or restricted 12

13 American Physical Therapy Association: Oncology APTA: Women s Health APTA: National Lymphedema Network: Lymphology Association of North America: clt-lana lana.org American Cancer Society: Cancer Information Service: Step Up, Speak Out: 1. Ridner SH, Bonner CM, Deng J, Sinclair VG. Voices from the shadows: living with lymphedema. Cancer Nurs. Jan-Feb 2012; 35(1):E Shaw C, Mortimer P, Judd PA. A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer. 2007;110: Helyer LK, Varnic M, Le LW, Leong W, McCready D. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J. 2010; 16: Schmitz KH, Ahmed RL, Troxel AB, et al. Weightlifting for women at risk for breast cancer-relatedrelated lymphedema: a randomized trial. JAMA. Dec 2010; 22; 304(24): Taylor R, Jayasinghe UW, Koelmeyer L, Ung O, Boyages J. Reliability and validity of arm volume measurements for assessment of lymphedema. Phys Ther. Feb 2006; 86(2): Czerniec SA, Ward LC, Refshauge KM, et al. Assessment of breast cancer-related arm lymphedema-- comparison of physical measurement methods and self-report. Cancer Invest. Jan 2010; 28(1): Moseley A, Piller N. Reliability of bioimpedance spectroscopy and tonometry after breast conserving cancer treatment. Lymphat Res Biol. 2008; 6(2):

14 8. Matthews K, Smith J. Effectiveness of modified complex physical therapy for lymphoedema treatment. Aust J Physiother. 1996;42: Ko D, Lerner R, Klose G, Cosimi B. Effective treatment of lymphedema of the extremities. Arch Surg. 1998; 133: Boris M, Weindorf S, Lasinski B, Boris G. Lymphedema reduction by noninvasive complex lymphedema therapy. Oncology. 1994; 8(9):95 106; discussion Liao S-F, Huang M-S, Li S-H, et al. Complex decongestive physiotherapy for patients with chronic cancerassociated lymphedema. J Formosa Med. 2004;103: Gawenda, R. Coding and Billing for Out-patient Rehab Made Easy. HCPro Healthcare Marketplace Accessed 5/1/13. 14

1. Skin care: Cleansing, lubrication, debriding and administration of antimicrobial therapy.

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