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LYMPHEDEMA

Presented by Katrin Gardarsdottir, LPTA, Cert.CDT

PERSONAL BIO

• Graduated from Tidewater Community College in 2001 with Associates

Degree in Applied Science, Physical Therapy Assistant Major

• Began working at Tidewater Physical Therapy, Inc. June of 2001 to present

• Earned my Certificate from the Academy of Lymphatic Studies as a

Decongestive Therapist in Sept of 2002.

• Certified compression garment fitter for Juzo, Jobst, and Circaid

LYMPHATIC SYSTEM

• It is a one way system that carries lymphatic fluid from the interstitial tissues to the

circulatory system

• Removes impurities from the body

• Returns excess water, protein molecules, and large molecules to the venous system

• Contains lymphnodes whose functions include

• Stimulation of the immune response

• Production of antibodies and lymphocytes

• Filters out tissue debris and foreign materials

LYMPHEDEMA

DEFINITION

Lymphedema occurs when

the lymph load exceeds the

transport capacity causing an

accumulation of fluid and

protein in the tissue spaces.

WHAT IS LYMPHEDEMA

• An incurable, but treatable condition

• A swelling of a body part(s), most often an extremity

• An abnormal accumulation of protein rich fluid in the tissue spaces

• Caused by a malfunction or disruption of any component of the system

• Increasing in incidence due to lifesaving caner treatments

• Usually progressive

PRIMARY

LYMPHEDEMA

• Congenital condition caused by

a malformation of the

Lymphatic System

• Lymphnodes can be Hypoplasic,

Hyperplasic, or Aplasic

SECONDARY

LYMPHEDEMA

• Caused by an insult to the Lymphatic

System

• Dissection of Lymphnodes

• Radiation

• Surgery

• Trauma

• Frequent Infections

• Chronic Venous Insufficiencies

SIGNS & SYMPTOMS

• Heavy or full feeling in the limb

• Sleeves or pant legs may feel tight

• Rings, bracelets, or watches may feel tighter than before

• Swelling

• Decreased flexibility or range of motion in joints due to swelling

COMPLICATIONS OF LYMPHEDEMA

• Pain

• Weakness

• Decreased ROM

• Decreased function

• Decreased immune system function

• Wounds

• Decreased wound healing

• Fungal infections

• Cellulitis

• Fibrotic tissue

• Lymph cysts or blisters

• Lymphorrhea

• Lobules and papilloma’s

COMPONENTS OF TREATMENT

• Manual Lymph Drainage (MLD)

• Compression Bandaging

• Compression Garments

• Daytime Compression Garments

• Night Time Compression Garment

• Patient Education

MANUAL LYMPH

DRAINAGE

Manual Technique that redirects

the flow of lymphatic fluid from a

congested area to an non congested

area where it can be filtered and

processed.

COMPRESSION

WRAPPING

Compression wraps are used during treatment to:

Prevent refilling of the limb between

treatments

Improve the muscle joint pump during activity

Supports tissues that have lost their elasticity

Breaks up fibrotic tissue

Increased tissue pressure improved

lymphatic and venous return

COMPRESSION GARMENTS

• Four different strengths ranging from 20mmHg to 60mmHg.

• Designed to hold the limb at the current size, they are not

designed to reduce the size of the limb

• Contraindicated to fit a swollen limb with compression garments

DAYTIME COMPRESSION GARMENTS

CIRCULAR KNIT GARMENT FLAT KNIT GARMENT

NIGHT TIME COMPRESSION GARMENT

REID SLEEVE CIRCAID

PATIENT EDUCATION

• Precautions

• Skin care

• Infection prevention and signs & symptoms

• Home management techniques

• Self Manual Lymph Drainage

• Self Bandaging

DIAGNOSIS CODES

• 457.0 Lymphedema

• 457.1 Post Mastectomy Lymphedema Syndrome

• 457.1 Secondary Lymphedema

• 757.0 Congenital Lymphedema

TREATMENT CODES

• CPT 97001 Initial Evaluation

• CPT 97110 Therapeutic Exercises

• CPT 97530 Therapeutic Activities

• CPT 97140 Manual Therapy

• CPT 97750 Physical Performance Test

DME CODES UPPER EXTREMITY

• HCPC L8010 Compression Sleeve

• HCPC L8010A Compression Sleeve with Glove

• HCPC L8010B Compression Sleeve with Gauntlet

• HCPC L3999D Compression Bra

• HCPC A6549A Compression Glove only

• HCPC A6549B Compression Gauntlet only

• HCPC A4465A Upper Extremity Night Device

DME CODES LOWER EXTREMITY

• HCPC A6530 Knee High Compression Hose, 20-30mmHg, Each Item



• HCPC A6533 Thigh High Compression Hose, 20-30mmHg, Each Item



DME CODES LOWER EXTREMITY

• HCPC A6539 Pantyhose Style Compression Hose, 18-30mmHg



• HCPC A6549 Custom Compression Garments both upper and lower

extremity

• HCPC A4465B Lower Extremity Night Device

BANDAGES

• HCPC A6441 Padding Bandage, eg Artiflex 3 units = 1 roll

• HCPC A6450 Light Compression Bandage, eg Idealbind 5 units = 1 roll

• HCPC A6451 Moderate Compression Bandage, eg Rosidal 5 units = 1 roll

• HCPC A6452 High Compression Bandage, eg Dauerbinde 7 units = 1 roll

BILLING

• Must have a prescription

• Letter of medical necessity

• Proof of delivery

• Advance Beneficiary Notice (ABN)

• Modifiers

CONTACT INFORMATION

Katrin Gardarsdottir, LPTA, Cert CDT

Tidewater Physical Therapy

12655 Warwick Blvd Ste B

Newport News, VA 23606

Phone 757-599-5551

Fax 757-595-5238

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