ICD-10 Codes: This the International Classification of Disease (ICD) and is mostly used for data collection purposes. It does not have an impact on coverage or payment. In Europe, the updated ICD-11 has a Lipedema (EF02.2) and Lipo-lymphoedema (BD93.1Y) code.
In the United States, typical ICD-10 codes used are:
R60.9 for edema M79.606 pain in leg M79.603 pain in arm
R52 pain unspecified E65 Localized Adiposity R26.2 DifficultyWalking
R58 Easy bruising R20.8 Other disturbances of the skin sensation
If the German ICD-11 codes for lipedema E88.20 to E88.28 are billed in the United States, they will be rejected.
Current Procedural Technology (CPT) Codes are what drive coverage and payment for lipedema.
Using the “traditional” liposuction codes (CPT 15877-15879) is fine for lipedema because there is data on payment for these codes that supports payments of $7,000 to $12,000 for professional surgery fees out-of-network. These code were historically used for less invasive procedures and conditions like lipomatosis, flaps, hypertrophic insulin lipodystrophy, evacuating hematomas, emergency neck defatting for airway restoration, and axillary hyperhidrosis. It is possible in negotiations with plans and payment appeals to use this fact in getting a higher payment.
Similarly, the excision codes which are used to remove excess skin after liposuction are billed under CPT Codes 15832, 15833, 15836 and 15839.
When billing the CPT codes, it is essential to have the correct “Modifier” attached. This tells the plan more about the surgery. Use the following three Modifiers:
CPT Modifier 50 – Used to report bilateral limb procedures. This signals the payer to pay for the 2nd limb at 50% versus not paying at all. It is better to “bundle” the two limbs together and let the payer make the reduction. Having the limbs separately creates the opportunity for errors.
CPT Modifier 59 – for trunk areas (buttocks, hips and stomach) to show separate areas or incisions made. You can bill once for each area using this modifier. Typically physicians bill for 2 areas but more is fine too.
CPT Modifier 22 – Added to all lipedema surgery codes to get an additional 10% due to the complexity of the surgery.