![]() Documentation should indicate clear objective evidence of improvement generally within the first week or 10 days of therapy (e.g., changes in weight, extremity circumference). The medical record must clearly indicate the patient’s condition before, during, and after the therapy episode to support that the patient significantly benefitted from ongoing therapy services and that the progress was sustainable and of practical value when measured against the patient’s condition at the start of treatment. The key issue is whether the skills of a therapist are needed, or whether the services can be carried out by the patient and/or caregiver after sufficient training. The end of treatment is not when the edema resolves or stabilizes but when the patient and/or caregiver are able to continue the treatments at home. There is only temporary benefit from the treatment unless the patient and/or caregiver are able to complete treatments at home on an ongoing basis. The goal of therapy is not to achieve maximum volume reduction but to ultimately transfer the responsibility for the care from the provider to the patient and/or caregiver, generally within a 1-3 week time period. Services must be under accepted standards of medical practice and considered to be specific and effective treatment for the patient’s condition.Services were provided by a qualified clinician (i.e., physician, non-physician practitioner (NPP), qualified therapist, or appropriately supervised therapist assistant).Prior unsuccessful therapies (e.g., elevation, bandaging, diuresis) reported to justify the need for skilled services.Recent changes in the patient’s condition.A diagnosis of lymphedema (not tissue edema due to other etiologies e.g., chronic venous insufficiency, congestive heart failure, acute infection).Medicare will reimburse for necessary components of decongestive treatment when the medical record supports Comprehensive Decongestive Therapy (CDT) which is a combination of MLD, bandaging, skin care and exercises.Manual Lymphatic Drainage (MLD) which stimulates the movement of fluids in the tissues using gentle massage and.The two basic types of decongestive treatment are: We are providing clarification of coverage and documentation requirements for lymphedema decongestive treatment based on Noridian medical review findings. Not endorsed by the AHA or any of its affiliates. Presented in the material do not necessarily represent the views of the AHA. Preparation of this material, or the analysis of information provided in the material. ![]() The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness orĪccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Resale and/or to be used in any product or publication creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions Īnd/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyĪuthorized with an express license from the American Hospital Association. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. AHA copyrighted materials including the UB‐04 codes andĭescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may beĬopied without the express written consent of the AHA. ![]() All rights reserved.Ĭopyright © 2023, the American Hospital Association, Chicago, Illinois. The AMA assumes no liability for data contained or not contained herein.Ĭurrent Dental Terminology © 2022 American Dental Association. The AMA does not directly or indirectly practice medicine or dispense medical services. Applicable FARS/HHSARS apply.įee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not AMA CPT / ADA CDT / AHA NUBC Copyright StatementĬPT codes, descriptions and other data only are copyright 2022 American Medical Association.
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