![]() ![]() ![]() In the United States breast cancer surgery is the most common cause of secondary lymphedema. The most common etiologies of secondary lymphedema include surgical procedures involving removal of the lymph nodes, obstruction of the lymphatic system by malignant tumors, local radiation treatment, and some traumatic injuries. Lymph transport is interrupted due to physical disruption or compression of lymphatic channels. Secondary lymphedema, which is more common, is an acquired defect of the lymphatic system. Primary lymphedema is a relatively uncommon condition that is usually congenital in nature, at times representing an inherent deficiency of the lymphatic system (e.g. Lymphedema can be divided into (1) primary and (2) secondary forms. Lymphedema is an abnormal collection of excessive tissue proteins, edema, chronic inflammation, and fibrosis that results in accumulation of this fluid in the interstitial spaces, principally subcutaneous fat, as a result of inadequate clearance by the lymphatic system. Lymph fluids consist of water, proteins, and other solutes that are found among interstitial tissues. The main function of the lymphatic system is to clear fluid from the interstitial tissues of the body and return it to the bloodstream via a system of lymphatic vessels and lymph nodes. In addition, it does not make any changes in the present policy regarding the use of segmented versus nonsegmented pumps. It also does not address edema of the upper/lower extremity that is not truly lymphedema. This decision memorandum does not address, nor does it make any changes in the policy regarding coverage of pneumatic compression pumps for the treatment of venous insufficiency, including treatment of venous stasis ulcers. Use of pneumatic compression devices for this indication has been referred for a technology assessment, and will be the subject of a separate decision memorandum. Pneumatic compression devices are also used to treat venous insufficiency. The memorandum serves four purposes: (1) outlines the description and treatment of lymphedema (2) reviews the history of Medicare coverage for pneumatic compression pumps in the treatment of patients with primary and/or secondary lymphedema (3) presents and analyzes the relevant clinical and scientific data related to the use of pneumatic compression pumps, and (4) delineates the reasons for revising the national coverage policy to distinguish between primary and secondary lymphedema, as well as remove the current coverage language referring to this therapy as a "treatment of last resort". ![]() Medical Officer, Division of Items and Devices Policy Analyst, Division of Items and Devices Pneumatic Compression Devices (Used for Lymphedema)Īcting Director, Division of Items and Devices Encourage patients to use compression garments between pump sessions to prevent reaccumulation of fluid.Īll other sections of this policy remain unchanged. A pneumatic compression device is covered if a physician determines after such a trial that there has been no significant improvement, or if significant symptoms remain.ģ. This garment does not need to be custom-fabricated however, it does need to be a graduated compression stocking/sleeve. A patient must first undergo a four-week trial of conservative therapy, which includes the use of an appropriate compression garment, exercise and elevation. A pneumatic compression device will not be covered as initial therapy for lymphedema in the home setting. The keystones of lymphedema treatment are elevation, compression and exercise.Ģ. Secondary lymphedema, which is much more common, results from the destruction of or damage to formerly functioning lymphatic channels, such as by surgical removal of lymph nodes, post radiation fibrosis or scarring, among other causes. Primary lymphedema is a relatively uncommon, chronic condition which may be due to such causes as Milroy's Disease or congenital anomalies. Lymphedema is divided into two broad classes according to etiology. Revise Coverage Issues Manual 60-16 so that:ġ. ![]()
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