Discussion: Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus

Abstract

D ialogue pertaining to the CPT coding system for lymphatic procedures is long overdue. We therefore commend the authors for their recent publication 1 and for bringing this matter to light, as there continues to be a lack of consensus around CPT coding of lymphatic operations. Recently, a greater clinical consensus has been developing in terms of procedural algorithms for the surgical management of lymphedema. History has shown that the standardization of best practices as demonstrated by the establishment of Centers of Excellence, along with consensus on CPT coding, will promote the passage of medical policy. Although we agree with the authors that CPT coding is an important step toward policy change, we also strongly believe that concurrent efforts toward standardizing the delivery of care are of equal importance. For example, recent progress toward clinical consensus has driven medical policy change to provide coverage for the surgical treatment for lymphedema in Massachusetts. 2 In the process of standardizing the CPT coding framework for lymphatic operations, it is also critical that consistent nomenclature be developed for these procedures. We have previously observed that how we document our procedures can significantly impact whether or not they are reimbursed. 2 We proposed a standardized framework of referring to lymphatic operations as "lymphatic reconstruction." Lymphatic operations performed for prevention would be termed "immediate lymphatic reconstruction"