Although I am not a physical therapist (PT), my activities as an advocate for patients with lymphedema bring me close to the profession, making me acutely aware of certain issues relating to the delivery of services to this patient population. I frequently encounter issues that I feel require more discussion and resolution to improve the quality of care provided to individuals with lymphedema.

One of these issues is the lack of adequate measuring tools with which to evaluate the severity of lymphedema in its early stages, when therapy can bring about the most effective results in prevention and management. The related issue of Medicare coding of lymphedema severity and its use in determining the outcome of therapy also needs discussion.

The universally accepted treatment of lymphedema, called "complex decongestive therapy," involves hands-on physical therapy performed by licensed PTs specially trained in lymphatic protocols. In Medicare, this comprises manual lymph drainage and compression bandaging (CPT code 97140), decongestive exercises (CPT 97110), self-care management training (CPT 97535), sequential pneumatic compression device patient education (CPT 97016), and compression garment measurement and fitting (not covered).