Today's Wound Clinic - Winter 2008 - (Page 40) intech PNEUMATIC COMPRESSION PUMP TYPES Pneumatic compression pump devices are classified as one of three types3. These three basic types are: 1. Type I—nonsegmented or single compartment pumps with a single outflow port 2. Type II—segmented or multichamber devices with multiple outflow ports and sequential filling of the chambers at a fixed pressure 3. Type III—segmented or multichamber devices with multiple outflow ports and sequential filling of the chambers with manual control of pressure parameters. It is important to note that Type II compression pumps are set up to deliver either the same pressure in each chamber segment or a preselected pressure gradient in each chamber segment. However, specific chamber pressures cannot be programmed by the clinician. In comparison, type III compression pumps may be programmed by the clinician to deliver specific levels of compression over particular inflation and deflation cycles. Some type III pumps allow the clinician to program specific levels of compression across each chamber segment. Examples of different types of compression pumps are listed in Table 1. mented by the attending physician, for patients who have failed conservative treatment for lymphedema or CVI with venous statis ulcers. However, pneumatic compression therapy will not be covered as initial therapy for lymphedema or CVI. Individuals with lymphedema must meet certain coverage criteria in order to qualify for a type I or II pneumatic compression pump.4,5 They must have a confirmed diagnosis of primary or secondary lymphedema and they must have undergone a 4week trial of conservative therapy Type I or II pneumatic compression therapy pumps are typically covered by Medicare.4,5 Type III pumps are considered medically unnecessary and are not covered unless the patient has certain medical conditions that warrant their use. Some Medicare reviewers currently indicate that there is a lack of research to support the use of type III devices. Editor’s Note: More Information on Medicare and commercial coverage is beyond the scope of this article but can be obtained at: www.cms.hhs.gov www.tricenturion.com The treatment of lymphedema with this therapy has become increasingly controversial in the past decade or so as more and more clinicians become certified lymphatic therapists. where symptoms did not improve or worsened. Conservative therapy includes elevation of the affected limb, exercise, massage, or use of an appropriate compression bandage system or compression garment. They must also have demonstrated compliance with the treatment plan of care. Likewise, patients with venous insufficiency and associated stasis ulcers must have had those wounds for 6 months and have undergone and failed a 6-month trial of conservative treatment. 4,5 Conservative treatment must have included a compression bandage or garment and moist wound healing treatments. Medicare also requires documentation showing ulcers have not completely healed. EVIDENCE FOR THE USE OF PNEUMATIC COMPRESSION PUMP THERAPY Pneumatic compression pump therapy has been used historically to treat both lymphedema and CVI. However, the treatment of lymphedema with this therapy has become increasingly controversial in the past decade or so as more and more clinicians become certified lymphatic therapists. Pneumatic compression pump therapy has fallen out of favor with the advent of increased training and exposure of clinicians in the US to both European and Australian lymphedema management protocols. It is thought that pneumatic compression pump therapy has the potential to damage the fragile lymphatic vessels in the dermis and that this form of compression removes the fluid component of lymphedema from the swollen interstitial spaces while leaving behind the proteins that have accumulated in these spaces.7 For practitioners who use compression pumps, it is recommended that short treatment times of 30 minutes to 1 hour, one to two times per day utilizing low-moderate pressures of approximately 30 mm Hg to 35 mm Hg, followed by compression bandaging. Intermittent, sequential compression pumps with manual controls and multiple chambers (10 to 12 in number such as that provid- REIMBURSEMENT Medicare, Medicaid, and most private insurers cover intermittent segmental, gradient pneumatic compression therapy for both lymphedema and chronic venous insufficiency (CVI) with venous stasis ulcers.4,5 In recent years, the coverage denials for pneumatic compression pumps has declined.6 Interestingly, there is a greater denial rate for CVI as compared to primary and secondary lymphedema. Pneumatic compression therapy is covered; if prescribed by a physician, if the physician provides appropriate oversight, and if certain criteria are met. Medical necessity must be well docu40 Winter 2008 Today’s Wound Clinic http://www.cms.hhs.gov http://www.tricenturion.com
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