Sample CSM letter to protest for Codes Lymphedma products

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Sample CSM letter to protest for Codes Lymphedma products

Postby patoco » Tue Apr 17, 2007 12:30 pm

Sample CSM letter to protest for Codes for Lymphedma products!

Dear Friends and supporters of Lymphedema patients:

By popular request, Bellisse has added an informational link to our website on the issue to get lymphedema products to be assigned appropriate codes by CSM. As you will read,that CSM is resisiting to do so. The meeting May 1st is our opportunity to join collectively and say 'NO!" - there are not appropriate codes for these products and there needs to be!

Please remember that TIME is of the essence - please write your letters to CSM today! A sample letter is provided below to give you some ideas.

Below is the link to all the background information on this very important 5/1/07 meeting with CSM for your information and use. ... odes.shtml

Only TOGETHER can WE - can make a positive change!



Below is a SAMPLE letter written by an impassioned OT who treats lymphedema patients and she graciously shared this letter with all of us. Please feel free to add in place, your own experiences in the body of the letter that you write. Just remember to please reference the HCPCS Code Change Request #07-109 and to address CSM's erroneous statement that they 'think' appropriate codes already exist - when we ALL know they do not!

Example letter to CSM:

HCPCS Workgroup at CMS

7500 Security Boulevard

Baltimore, MD 21244

Re: HCPCS Code Change Request #07-109

To: HCPCS Workgroup at CMS

I work closely with patients who are cancer survivors. Often times, they suffer from a condition known as lymphedema. This condition, contrary to some opinion, can become debilitating and pose health risks for the patient. Many physicians view lymphedema treatment as "purely cosmetic" considering that the cancer has been eradicated and that the lymphedema is an unfortunate side effect. I challenge all of those medical professionals to live with an arm, leg or breast that is 3 times the size of the other one, so large and engorged with fluid that it is nearly impossible to comb your hair, feed yourself, take care of personal hygiene tasks or even tolerate a hug from a loved one. I also challenge them to live with one or worse yet, two legs that are so large that walking for exercise is impossibility. When left untreated, these huge legs become fibrotic and venous insufficiency becomes a reality, risking amputation or repeat infection. Often the lymphedema will manifest itself in the trunk or breast areas, making it very swollen and painful to even be touched, let alone wear a bra.

In my years as a therapist, I have experienced the progress of numerous patients. I have witnessed a woman lose 53 pounds of fluid in her right leg alone!!! Imagine walking with a toddler hanging from your leg for a life time!!! The course of treatment for lymphedema reduction and management varies from one school of thought to another, but they all agree that daily management once the reduction is achieved is nightly and daily compression. This compression is best achieved with specifically designed garments that are created to address lymphedema alone. The patients work hard with the therapists to achieve the reduction goals and deserve to be provided with the proper garments to make daily management possible.

Much like a diabetic takes blood sugar levels and insulin daily, a person with high blood pressure takes medicine daily, and a person with poor vision wears glasses daily, the patient with lymphedema needs to manage their condition daily. This includes self manual lymph drainage, therapeutic exercise, skin care, as well as daily and nightly limb or trunk compression with specially designed garments.

I understand that the only issue cited as a reason for the preliminary rejection of the coding change request is as follows:

"No insurer (i.e. Medicare, Medicaid, Private Insurance Sector) identified a national program operating need to establish unique codes to distinguish all the products listed in this application. Existing codes adequately describe the array of products available."

I have personal experience with this fallacy. The existence if a code that covers garments for lymphedema does not exist. The "miscellaneous" code that we are forced to use is not covered by the vast majority of payers, including Medicare. It is a crying shame that the patients who are already dealing with a mass of medical bills are forced to put out hard earned money for garments that can so easily be provided for in order to maintain a healthy and functional body. It might - and probably would - save the medical system money in the long run by avoiding more expensive medical conditions if these patients could afford these therapeutic compression garments.

Please reconsider the rejection for the code change request #07-109!!! Imagine that your most adored family member is sentenced to endure the pain of lymphedema for a lifetime. Imagine that your most loved one is not able to take care of personal hygiene tasks independently, all for the sake of not being able to receive a simple compression garment, chip or foam pad and or bandages. We are not asking for much, just for you to approve appropriates codes for all types of lymphedema garments, bandages and specialty products that help these patients manage their lymphedma.

Thank you for your time and consideration,


Pat O'Connor
Lymphedema People
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