by Guenter Klose
MLD/CDT Certified Instructor, CLT-LANA
The conversion from ICD-9 to ICD-10 coding is likely to cause confusion for all health care professionals involved in lymphedema care. In this link, ICD-10-CM Expansions of Lymphedema Diagnostic Codes, you’ll find a helpful conversion list that was compiled by LymphActivist Robert Weiss, M.S.
With the new coding system, various levels of diagnosis codes can be layered into a longer code. In addition to describing the core diagnosis, e.g. Post-Mastectomy Lymphedema which was 457.0 but is now 197.2, the new system allows you to describe the location of the lymphedema. For example, Post-Mastectomy Lymphedema of the right upper extremity would be coded as 197.211.
In addition – and where it gets more complicated – are the additional two levels. Here is where therapists add one code to represent co conditions (comorbidities) and another code to represent severity of the lymphedema (stage 1, 2, or 3). Because therapists are not supposed to diagnose patients, by adding these next two levels of coding, a therapist is likely crossing the line into diagnosing. However, at least for the first year, therapists can bill with just the foundation code; they do not need to add any additional codes to get reimbursed.
In the past, therapists would often prepare a script with the proper diagnosis code for the doctor to sign-off on because physicians are typically unfamiliar with the coding for lymphedema. We are hopeful that, within the first year of implementation, the referring physicians might become more familiar with the process and take on the responsibility of proper coding. Another possibility is that, for lymphedema billing purposes, insurances and Medicare will continue to accept just the first 4 numbers (the foundational code), even after this first year.
At Klose Training, we’ll monitor how these new changes impact the documentation and reimbursement of Certified Lymphedema Therapists and update this article as we are able to.
Thank you to LymphActivist Bob Weiss for providing the nicely-organized list of ICD-10-CM codes on his website, and Linda Hodgkins, OT, CLT-LANA for sharing her invaluable insight during this conversion period.