Lymphedema Therapy Source

  

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Billing for Compression (part 3)

We’ve been talking about how a therapist can bill for compression in light of the passage of the Lymphedema Treatment Act. Last month, we noted there were (3) models. The third model involved:

  • a therapist billing Medicare for compression as a supplier & for service as a provider for their own patients, and
  • the same therapist also billing for compression for people who are not their patients.

This gets tricky because the model gives rise to unique ownership concerns related to Medicare & Medicaid payments. (Government complicates things.) These concerns revolve around federal statutes & criminal liability. That’s the focus of this month’s blog.

Disclaimer: Information is not guaranteed to be comprehensive or accurate. Consult a healthcare law attorney for guidance.

Model 3

You would think billing for other people’s patients could be done in your therapy business. But that’s not the case – unless the individual is your patient. And would another therapist want to refer their patients to you – a competitor? Of course, there are several people seeking compression that aren’t wanting treatment. They just need someone who can bill insurance. But does billing for a supply item constitute someone becoming a patient?  Besides that, the 42 CFR has special considerations for therapists billing for compression for their own patients that doesn’t apply to therapists billing for individuals who are not their patients. (See April’s blog update.) A seemingly easy solution is to have a second business.

If you have a second business for DME, why not simplify things? Keep your therapy services in the therapy business & the DME in a DME business. You could have both businesses in the same location & save on costs (like rent). Additional benefits could include having a different taxonomy code (for potential better reimbursement rates), less confusion among insurance payors, & legal protection from financial losses.  You could refer your therapy patients to the DME business. Right? Wrong. (Why not? Well, government complicates things.)

Medicare Supplier Standards2

Anyone who plans to bill federal healthcare programs for DME must be mindful of the 42 CFR Supplier Standards. One of those standards states a supplier is prohibited from sharing a practice location with another Medicare provider or supplier. But there are a few exceptions. Two of these include:

  • a therapist (i.e. provider) who is billing DME for their own patients only
  • a DME supplier can be co-located with & owned by a Medicare provider (e.g. therapist), but the businesses must operate separately (separate phone lines, separate computers, separate staff, etc.). You must also meet the definition of a Medicare provider.7,8

It would seem you actually could separate the therapy business & refer your patients to your DME company. But that’s not the case. (Did I mention government complicates things?)

The Anti-Kickback Statute

The Anti-Kickback Statute is one of the fraud & abuse laws mentioned last month. It was an amendment added to the Social Security Act & first passed by Congress in 1972 as an effort to prevent fraud & abuse of federal healthcare programs (i.e. Medicare & Medicaid).6 It can be found in Title 42 of the U.S. code which covers public health & welfare. (These laws are broken down into titles, chapters, subchapters, parts & sections.)3,4 Specifically, Section 1320a-7b talks about the Anti-Kickback Statute. This amendment prevents giving or receiving anything of value (e.g. money, free rent or other perks) for generating healthcare business paid for by federal programs.

In other words, if you had two businesses that billed Medicare or Medicaid, & you wanted to refer patients from one to the other, you can’t. (Unless, of course, you don’t mind jail time & hefty monetary penalties. Most therapists try to avoid these.) There are a few “safe harbor” exclusions that will allow such business transactions.5 But all elements of a safe harbor must be met. (And these have pros & cons.)

Two notes: First, this only applies to providers/suppliers billing federal healthcare programs (clarification is needed as to whether the non-direct plans like the exchange programs provided by commercial plans are included in this). Second, you can still have a therapy business providing therapy services & DME to your own patients. You can also have a separate DME business for other people’s patients in addition. But these must operate entirely separately & cannot refer business between them if you bill federal healthcare programs unless you fall within one of the safe harbor exclusions. You would also be wise to consider other mitigating factors to prevent implication of Anti-Kickback Statute violation.

There’s one more question that comes to mind regarding billing. What if a Medicare patient wants to pay cash for an item? We’ll look at that next month.

References
1 https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/
2 (supplier standards) https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-424/subpart-D/section-424.57
3 https://www.govinfo.gov/app/details/USCODE-2010-title42/USCODE-2010-title42-chap7-subchapXI-partA-sec1320a-7b
4 https://uscode.house.gov/
5 (safe harbors) https://www.ecfr.gov/current/title-42/chapter-V/subchapter-B/part-1001/subpart-C/section-1001.952
6 https://www.whistleblowerllc.com/anti-kickback-statute/#:~:text=Congress%20first%20enacted%20the%20AKS,physicians%20corrupt%20medical%20decision%2Dmaking.
7 (clinic definition) https://www.govinfo.gov/content/pkg/USCODE-2011-title42/html/USCODE-2011-title42-chap7-subchapXVIII-partE-sec1395x.htm, https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R5BP.pdf & https://www.ssa.gov/OP_Home/ssact/title18/1861.htm
8 (OTPP definition) https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R5BP.pdf

Attribution
Photo by Olia Danilevich Pexels

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Compression Garments & Insurance (part 5/5)

Because of the Lymphedema Treatment Act, Medicare will now cover lymphedema compression, supplies & aids with the appropriate diagnosis code & medical necessity. What items are covered & how do you get them?

Diagnosis Codes

A diagnosis code must be written on a physician order. Appropriate diagnosis codes1 to qualify for the new lymphedema benefit category are

  • I89.0 Lymphedema, not elsewhere classified
  • I97.2 Post-mastectomy lymphedema
  • I97.89 Other postprocedural complications & disorders of the circulatory system, not elsewhere classified
  • Q82.0 Hereditary lymphedema

Medical Necessity

A patient must have a medical necessity for the ordered item(s). Medical necessity is proven by physician order & supportive documentation. A physician order can be signed by a “treating practitioner,” meaning, a medical doctor, doctor of osteopathy, podiatrist, physician’s assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS).2,3 The following must be on the “standard written order.”2

  • The name of the treating practitioner, their NPI (national provider identifier), their signature & the date
    • stamps can’t be used; signatures & dates can be electronic or handwritten1,4
  • The beneficiary’s name (the patient’s name) & Medicare number
  • Description of the item(s) (such as the HCPCS code1)
    • options or features constituting an upgrade above the basic item must be listed separately on the order (such as upgrading from an off-the-shelf hose to a custom hose or adding a lining, zipper or pocket to a custom garment, etc.)
    • supplies must be listed separately on the order (such as a donning frame, donning gloves, etc.)
  • The quantity to be dispensed.

Supportive documentation (if requested) would include medical or therapy notes. (Note: Some DME requires a face-to-face encounter with the treating practitioner within 6 months of an order.5 Lymphedema items are not currently on that list.)

Compression Supplies Covered

Phase 1 of lymphedema treatment (the reduction or decongestion phase) requires decongestion supplies. This typically includes a cotton liner, a padding layer & several short-stretch bandages. At times, a Velcro reduction garment or wound kit might be used instead.

For coverage, supportive documentation must include justification for the quantity & frequency of these items. In my experience, two sets of supplies are needed (one to use & one to wash). Each set can be laundered & reused each session. (Avoid bleach, fabric softener, Woolite, dryer use or placing items in the sun as these things can damage the elastic fibers.)

When it comes to billing, a supplier will need to line-item each compression bandaging supply, accessory, wrap or garment that doesn’t have a unique HCPCS code with one of the following best-matched HCPCS codes:

  • A6549 – Gradient compression garment, not otherwise specified
  • A6584 – Gradient compression wrap with adjustable straps, not otherwise specified
  • A6593 – Accessory for gradient compression garment or wrap with adjustable straps, not otherwise specified
  • A6609 – Gradient compression bandaging supply, not otherwise specified.

The supplier will also need to add:1

  • a description of the item (including the inch, foot or yard for supplies)
  • manufacturer name
  • product name & number
  • supplier price list
  • HCPCS of a related item.

Billing modifiers are needed as well (right, left, replacement – if an item is lost, stolen or damaged, etc.).

All therapists & patients should be good stewards & conservative in their utilization of this benefit. Abuse & waste will cause problems down the road (be it increased government debt, higher taxes or another outcome).

Compression Garments Covered

Phase 2 of lymphedema treatment is the maintenance phase. This is when compression garments are needed to maintain the volume loss attained in Phase 1. Medicare covers these garments which may include:

  • off-the-shelf or custom (for all body parts) (typically flat-knit, circular-knit or Velcro)
  • day &/or night garments (typically Velcro or foam garments).

Medicare allows for:

  • (3) daytime garments every 6 months
  • (2) nighttime garments every 24 months

    (Note: There are two situations in which additional compression may be covered. The first is if an item is lost, stolen or damaged. The second is if there is a change in the patient’s status or condition. Either situation will require a new order & the replacement clock will start over.1)

Garment Aids Covered

Many patients are not aware there are several donning & doffing aids available to help get compression on or to remove it. There are donning frames, slippery material, gloves & other tools your therapist may know about. Justification for the quantity of supplies & the frequency of dispensing must be supported by documentation.

YouTube
Check out the Lymphedema Savvy YouTube channel for an upcoming treatment vlog. Information about the Lymphedema Treatment Act & billing will be included in a future video.

*****UPDATE 07/22/24*****

The following educational handouts were provided by the Lymphedema Treatment Act:

Patients
Providers
Suppliers

*****UPDATE 02/19/25*****

The current list of HCPCS lymphedema compression billing codes can be found here. The US Medical Compression Alliance has noted Medicare approval of additional codes here (effective April 1, 2025). They are specifically listed in Medicare’s Final Rule here. Medicare Learning Network (MLN Matters publication) provides billing tips here.

References
1 (coverage) https://www.cgsmedicare.com/jc/pubs/news/2023/12/cope147943.html
2 (orders) https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=55426
3 (physician) https://www.ssa.gov/OP_Home/ssact/title18/1861.htm
4 (signatures) https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c03.pdf
5 (face to face) https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/medical-review-and-education/dmepos-order-requirements or https://www.federalregister.gov/documents/2023/01/17/2023-00718/medicare-program-updates-to-face-to-face-encounter-and-written-order-prior-to-delivery-list#:~:text=For%20items%20on%20the%20F2F,of%20the%20written%20order%2Fprescription.

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Lymphedema Savvy

Goals

January 1st, 2024. It’s a new year. And it’s 5:52 am. I’m sitting at my desk contemplating this month’s (& this year’s) blog theme. The new year is a time to begin fresh, to start anew, envisioning what you want to happen in your future & contemplating the past. I’m ever amazed at how quickly January 1st comes. And ever disappointed I didn’t accomplish all I wanted the past year. Why is that?

(Photo by cottonbro studio / Pexels)

No matter how hard we try, life seems to derail the best intentions. Intentions to lose weight, quit smoking, spend more time with family, get more sleep, exercise, save money, accomplish that long-term goal. Like any good travel plans, you have a destination (what you want to accomplish) & a map (or GPS…how you’re going to get there). But you have to check in once in a while to make sure you’re on the right track. The one goal I wanted to get done was the launch of the Lymphedema Savvy Treatment Vlog. It didn’t get done. Let’s “check in.”

A Year in Review

As I reflect on the past year, a lot has been accomplished.

The Clinic

The clinic re-opened in 2022 after settling in a new location. By early to mid-2023, decorating, storage & organization was complete. The business re-credentialed to be in-network with major insurance companies. Systems, processes & operations (intake, benefit verification, billing & documentation) were reviewed. Legal & financial aspects taken into consideration along with marketing ideas & vendor connections.

(before & after)

Durable Medical Equipment (DME) – i.e. compression garment billing

With the Lymphedema Treatment Act passage, the DME currently provided in the clinic is switching to a separate business for insurance billing. That requires accreditation, insurance credentialing, new vendor accounts, etc. It’s “complicated.” You can read more about the Lymphedema Treatment Act in the recent blog posts.

The YouTube Channel

The Lymphedema Savvy YouTube channel launched in 2021 with subsequent plans to create the treatment vlog. The vlog would feature video from patient treatment sessions (with patient approval) to raise awareness about lymphedema & conditions that cause it. But it has been quite a journey. From learning technology to losing data (more than 2 years of recording). From obtaining a trademark to setting up interviews. It’s been a challenge! Check out the revised (“after data loss”) intro below. It is coming!

Happy New Year! I hope you accomplish all you desire in 2024.

Lymphedema Treatment Vlog

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Why Would Treatment Not Work (Part 3)

Reason 3 – Medical Staff or the Patient

In parts 1 & 2, we looked at two reasons CDT (complete decongestive therapy) may not work.

  • Combined edema & lymphedema
  • Inappropriate application of CDT (such as leaving one of the four components of treatment out, incorrectly applying technique or inadequate frequency).”

In part 3, we’ll look at the medical professionals & the patient’s role.

(photo by Pexels/Leeloo Thefirst)

Medical Doctors

A doctor may incorrectly diagnose a person with lymphedema, or they may overlook another condition causing swelling that is not lymphedema. And/or these other conditions causing swelling may not have been adequately treated. Additionally, compression garments recommended by a physician may not be the appropriate type or the right compression class.

Therapists

Therapists may also be a reason CDT doesn’t work. First, the therapist may not have actually gotten appropriate training (i.e. they may not have attended a 135-hour lymphedema training course in CDT yet say they “treat lymphedema”). Second, they may have attended an appropriate CDT program to treat lymphedema but may not have sufficient experience. According to Foldi,1 “Therapeutic success cannot be expected if errors are made in administering the treatment. The necessity of daily treatment has already been noted. Furthermore, we must again emphasize that a … therapist who has just received a certificate authorizing him or her to perform CDT is a novice & needs to get experience.” The text continues, “A “10-year rule” states that it takes approximately a decade of heavy labor to master any field!” The following are listed as the most common errors made by therapists.

  • Gross technical errors (such as failing to remove a bra which causes constriction)
  • Failure to treat the patient on a daily basis
  • Failure to apply bandages properly

Patients

Surprisingly, some patients may cause “artificial lymphedema” through constriction of a tourniquet or other means (& in some cases, deny it for reasons such as disability income). But in most situations (in my experience), failure on the part of a patient is due to non-compliance. Non-compliance can be not showing up for appointments, removing bandages to shower, not performing exercises prescribed, or not wearing a compression garment (including separate daytime & nighttime garments which are typically needed for pure lymphedema).

References
1 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 281-282. Germany: Urban and Fisher. Foldi, M., & Foldi, E. (2012). Foldi’s Textbook of Lymphology (3rd ed.). Urban and Fisher.

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Why Would Treatment Not Work (Part 2)

Reason 2 – Inadequate Treatment

In part 1, we looked at one reason CDT may not work. In part 2, we’ll look at the important components of lymphedema treatment.

Complete Decongestive Therapy (CDT) involves (4) pillars of treatment:

1. Manual lymph drainage (MLD)
2. Multilayer compression bandaging
3. Skin Care
4. Exercise

If one of these is lacking (particularly 1, 2 & 4), a patient will not maximize their potential. Let’s look at each of these individually.

Manual Lymph Drainage

The purpose of MLD is to remove the protein in the interstitial tissue space. (The protein accumulation is due to damage of the lymphatic system – from a birth defect or a secondary cause.) Bandaging without MLD might squeeze the “water” from the tissue space, but it won’t remove the protein (neither will diuretics). That’s a specific function of MLD. And if protein attracts water, what will the result be? More swelling.

I’ve recently read & heard that there isn’t proof that MLD works. But there is research to back the efficacy of MLD.

  • In a 2017 study published in the Lymphatic Research and Biology Journal, near-infrared imaging was used to track a dye (indocyanine green) in nine healthy participants before & after a 15-minute period of MLD followed by a compression garment for 10 minutes applied to the arm. Images were taken at the forearm & elbow. There was a statistically significant improvement in the movement of lymph fluid & the speed of transport. At baseline, lymph transport speed was 6.7 millimeters per second (mm/s). This increased to 13.3 mm/s after MLD! Speed increased by 10.5 mm/s after use of a compression garment.3
  • Another study published in 2011 also used near-infrared imaging to assess the speed of lymph contractile function before & after MLD. Results showed lymph transport speed increased by 23% in symptomatic limbs (ones with lymphedema) & 25% in asymptomatic limbs (ones without lymphedema).4

Characteristics of MLD include a gentle, 2-way stretch of the skin (approximately 1 stretch per second8) that create a “pulling & shear force.”12 If too much pressure is applied, anchoring filaments of the initial lymphatic vessels close to the skin’s surface may be damaged. If MLD strokes are performed too fast or too firm, lymphangions may spasm.8  Frequency of MLD should be daily in Phase I (the decongestion phase).1 If MLD is not administered correctly or with less frequency than recommended, results will show it.

Multilayer compression bandaging

Compression is an essential part of CDT. According to Foldi’s Textbook,1 a study from the European Journal of Cancer assessed the outcome of MLD in breast cancer-related lymphedema. The study found that MLD reduces limb volume & dermal (skin) thickness in the upper arm.5 In contrast, the 9th edition of the Munich Cancer Center manual reported a deterioration in arms of women with lymphedema who received lymph drainage but did not wear compression sleeves.

The International Lymphoedema Framework publishes a best practice guideline for compression.6 The upper body guideline states, “The application of a compression garment results in constant pressure on the skin when the limb is at rest (resting pressure). When the muscles contract, expand and then relax (e.g. during exercise), they transiently press against the resisting garment and so the tissue pressure in the limb increases temporarily.” This pressure increase “compresses the adjacent dermal lymphatics and because the collecting and larger lymphatics are valved, these vessels pump passively so that lymph flows up the arm without the lymphatics having to contract.” In other words, the resistance provided by compression increases tissue pressure &, as a result, lymph movement.

Other benefits of compression include softening of fibrotic tissue & improving the venous pump function.10 Foldi states, “In lymphedema, one should always use the maximum compression that is tolerated by the patient.”7 (A 2016 study found 84 mmHg compression stopped lymphatic flow.8 This is extremely high pressure. Compression seldom goes above ~46 mmHg in lymphedema garments & limb size should be considered. Smaller circumferences like fingers & arms will not tolerate the same compression that legs might.)

Compression is an important component of CDT. If it is lacking in the treatment phase or maintenance phase, there will not be sufficient volume reduction or containment. If compression bandages are removed between sessions, refilling will occur. And if bandages are not applied correctly, there can be adverse consequences such as increased swelling or pressure wounds.

Skin Care

Good hygiene & using acidic products more like the skin’s natural pH level will reduce itching & improve skin texture. These will also help mitigate potential infections due to a compromised skin barrier.

Exercise

When the body is at rest, only a minor amount of lymph is formed.12 Movement is key to lymph creation. Exercise engages the muscle pump. Singing, deep breathing & laughing are excellent ways to engage the diaphragm & compress the most important lymph vessel in the body (the thoracic duct).11 Exercising with compression increases tissue pressure (& so lymph movement) & softens fibrosis in extremities (helping to reduce volume).

In summary, all aspects of CDT are important components. If one is overlooked or administered inadequately, CDT may fail at worst or results may be subpar at best.

References
1 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 272. Germany: Urban and Fisher. Foldi, M., & Foldi, E. (2012). Foldi’s Textbook of Lymphology (3rd ed.). Urban and Fisher.
2 https://www.lympho.org/publications
3 Lopera C, Worsley PR, Bader DL, Fenlon D. Investigating the Short-Term Effects of Manual Lymphatic Drainage and Compression Garment Therapies on Lymphatic Function Using Near-Infrared Imaging. Lymphat Res Biol. 2017;15(3):235-240. doi:10.1089/lrb.2017.0001
4 Tan IC, Maus EA, Rasmussen JC, et al. Assessment of lymphatic contractile function after manual lymphatic drainage using near-infrared fluorescence imaging. Arch Phys Med Rehabil. 2011;92(5):756-764.e1. doi:10.1016/j.apmr.2010.12.027
5 Williams AF, Vadgama A, Franks PJ, Mortimer PS. A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. Eur J Cancer Care (Engl). 2002;11(4):254-261. doi:10.1046/j.1365-2354.2002.00312.x
6 Moffatt, CJ, et al. International Lymphedema Framework. (p. 13)
7 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 273. Germany: Urban and Fisher. Foldi, M., & Foldi, E. (2012). Foldi’s Textbook of Lymphology (3rd ed.). Urban and Fisher.
8 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 526. Germany: Urban and Fisher. Foldi, M., & Foldi, E. (2012). Foldi’s Textbook of Lymphology (3rd ed.). Urban and Fisher.
9 Belgrado JP, Vandermeeren L, Vankerckhove S, et al. Near-Infrared Fluorescence Lymphatic Imaging to Reconsider Occlusion Pressure of Superficial Lymphatic Collectors in Upper Extremities of Healthy Volunteers. Lymphat Res Biol. 2016;14(2):70-77. doi:10.1089/lrb.2015.0040
10 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 568-569. Germany: Urban and Fisher. Foldi, M., & Foldi, E. (2012). Foldi’s Textbook of Lymphology (3rd ed.). Urban and Fisher.
11 Shields, J. (1992). Lymphology, v25, n4, Dec. 1992, p. 147* & Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 550. Germany: Urban and Fisher. Foldi, M., & Foldi, E. (2012). Foldi’s Textbook of Lymphology (3rd ed.). Urban and Fisher.
12 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 198. Germany: Urban and Fisher. Foldi, M., & Foldi, E. (2012). Foldi’s Textbook of Lymphology (3rd ed.). Urban and Fisher.
* https://lymphaticyoga.net/deep-breathing-and-the-lymphatic-system/ cites Dr. Shields as saying, “Deep diaphragmatic breathing stimulates the cleansing of the lymph system by creating a vacuum effect which pulls the lymph through the bloodstream.” I cannot find this statement in the cited article posted by the author. (https://journals.uair.arizona.edu/index.php/lymph/article/view/17643/17366)

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Breast Cancer: What to Expect in Treatment

If you or your doctor decide you need to see a therapist for lymphedema, what should you expect? And if you do get treatment, will it work?

In the Beginning

The first session will be an evaluation to assess the status of your lymphedema. A therapist will gather background information such as your past medical history and take baseline measurements. They may also take photos (particularly if you have wounds). This session will enable the therapist to establish a plan of care outlining what they plan to do to in treatment and collaborate with you on goals.

Phase I – Complete Decongestive Therapy

Subsequent sessions will involve treatment and education. This is Phase 1. Treatment for lymphedema is complete decongestive therapy (CDT) which includes manual lymph drainage, bandaging, skin care and exercise. Let’s look at each one of these components.

(Hands Massage photo by Andreas 160578-Pixabay)

  • Manual lymph drainage is a medical massage used to stimulate lymphatic fluid movement. It is used to decongest the swollen area and re-route fluid to healthy lymph nodes when appropriate. It’s a slow, rhythmic manual technique that has numerous benefits outside of lymphedema for general health and wellness. But in this case, it is specifically used to remove stagnant lymph fluid causing swelling in an extremity. The massage is also very gentle and light so as to avoid damaging the fragile lymphatic vessels that sit near the skin’s surface. The exception is when there is fibrotic tissue (tissue that has become firm due to congestion and inflammation caused by a damaged or impaired lymphatic system.
  • Bandaging is an essential part of treatment. It is done with several layers of special bandages called short-stretch bandages (this type of compression bandage stretches a short distance when pulled). These are applied over a padding layer and provide resistance during movement or exercise. The bandages help break down fibrotic tissue and stimulate lymph movement. But they also prevent fluid that has been removed from refilling an area that is being decongested.
  • Skin care is important because your skin is a barrier to bacteria. And skin changes are seen in lymphedema as the condition progresses. Initially, skin becomes thicker. Later papules (bumps), hyperkeratosis (excess skin growth), discoloration and other skin changes can occur. As this continues, your risk of a cellulitis infection goes up. Education about appropriate skin products and skin protection should be a component of skin care.
  • Exercise promotes lymph movement through muscle pumping action. While most any movement is beneficial, deep breathing and use of the involved extremity will likely be part of your exercise program.

Phase 2 – Maintenance

At the end of treatment, you will need a compression garment for maintenance (most likely one for daytime and another for night use). This is Phase 2. Some therapists will fit you for these, but many therapists will refer you to someone else who specializes in fitting garments.

Example of a garment (in this case: open-toe, circular-knit hose)

The above is the gold standard and conservative treatment for lymphedema. The next question is: Does treatment work? While there is anecdotal evidence, fortunately, there is scientific research backing the claims of CDT and the individual components of this treatment (and has been for many years).1-3

Once in a while, treatment may not be effective. Why would this be? We’ll look at that next time.

References
1 Michopoulos E, Papathanasiou G, Vasilopoulos G, Polikandrioti M, Dimakakos E. Effectiveness and Safety of Complete Decongestive Therapy of Phase I: A Lymphedema Treatment Study in the Greek Population. Cureus. 2020;12(7):e9264. Published 2020 Jul 19. doi:10.7759/cureus.9264
2 Foldi Textbook of Lymphology
3 Lymphedema A Concise Compendium of Theory and Practice

Contact Us

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Little Elm, Texas 75068-5196
214-422-8265 | 469-579-5034
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info@LTStherapy.com

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