Physicians
Durable Medical Equipment
Durable Medical Equipment is available for your patients, but a number of new issues have been introduced by CMS and other insurance companies. In recent years, CMS introduced the “face-to-face” rule. The exam must occur within six months prior to prescribing the DME item, and the exam occurrence must be documented in the patient’s medical record.
The exam must include and document
- Evaluation of the beneficiary.
- Needs assessment.
- Treatment, including all previous treatments.
- Relevant diagnoses, including the cause of the lymphedema.
- Clinical notes supporting the medical need for the DME ordered.
The signed DME item order alone is not sufficient.
For more information contact us
Phone: 1.800.876.3563
Fax: 1.800.908.3554
ICD-10 Codes Used for Lymphedema Pumps
Medicare and many insurers recognize the following codes for qualifying for a lymphedema compression pump. Other codes may fit a patient better clinically, but some insurers may not recognize them as qualifying pump diagnoses.
I89.0 – Lymphedema, not elsewhere classified.
I97.2 – Post-mastectomy lymphedema syndrome.
Q82.0 – Hereditary lymphedema.
I87.2 – Venous insufficiency (chronic) (peripheral).
I87.2 – Venous insufficiency with ulcer documentation requirements. Many insurers, especially Medicare, require documentation of an ulcer for six months before approval.
I87.319 – Chronic venous hypertension (idiopathic) with ulcer of unspecified lower extremity.
Important coding note
These current codes must be used on all CMNs, and they must match the codes used in clinical notes and records. It is best to enter these codes early into patient records if the condition is present and pump treatment may be considered later. Please do not forget notes about elevation and compression stocking use. Insurance companies generally require documentation of these measures before a compression pump is approved. If a patient cannot use a stocking, that failure should also be documented in the notes.