As vein specialists, one of the most frustrating conditions that we treat is chronic bilateral lower extremity edema. We all know that pneumatic compression pumps can make a big difference for these patients, but they are very expensive. So, what do we need to provide to Medicare and private insurers to get these covered?

Consider the following suggestions:

1. Diagnosis: Primary Lymphedema or Secondary Lymphedema due to Chronic Venous Insufficiency. ICD 10 I89.0 is secondary lymphedema and is a good code to get it covered.
2. Elevation: documented in the notes.
3. Exercise: documented in the notes.
4. Compression: At least 2 notes that establish a 28-day timeframe that the patient has attempted compression and that edema is persistent. (Unna boots, Compression stockings, Tubigrip, multilayer wraps)
5. If venous ulcer is your diagnosis, you must document that there is an active wound (when appropriate).

Consider adding a template, such as the following, to your EMR that can be modified to fit your patient’s condition:

This patient has lymphedema secondary to chronic venous insufficiency. The patient has chronic lower extremity edema that has not been improved with conservative management. The patient has been wearing compression stockings for the past several months. Daily walking exercises and elevation of the extremities also has not been helpful. I recommended that the patient use sequential compression pumps to help relieve this edema. I also recommended that the patient exercise and elevate the legs as much as possible.

Lastly, you need to use ICD10 codes to support your diagnosis. Here are some helpful examples:

I89.0 Secondary Lymphedema
Q82.0 Primary Lymphedema
I87.2 Chronic Venous Insufficiency
L97.111-929 Non-pressure chronic ulcer of the leg.

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