As part of the Munich self-help group, I regularly meet people who are at a loss and who are overwhelmed with the course of therapy, especially after the diagnosis has been made. Therefore, I have put together the most frequently asked questions (FAQ = frequently answered questions) on the subject of long-term remedy needs for you.
Since 2017 there have been some innovations in the field of lymphology.
Prescription of manual lymphatic drainage (MLD) for lipedema?
In the current S1 guideline on lipedema agrees that physical measures in the form of complex physical decongestion therapy (CPE) are used to reduce edema and pain. This includes the Manual lymphatic drainage, compression therapy, exercise therapy and skin care.
The way food is National Association of Statutory Health Insurance Physicians conveys in this regard that lipedema is also known as lipolymphedema and therefore the classification of the indication code on the prescription under LY1 or LY2 is possible, which in turn means that MLD can be prescribed.
How is the course of therapy designed "as a rule"?
After the diagnosis one goes through the so-called normal case. This means that the MLD can be prescribed as follows:
- Initial prescription with up to 6 units
- 4 subsequent ordinances with up to 6 units each
- Maximum of 30 units in total (e.g. 5 x 6 units)
The health insurance companies then require a 12-week break before the prescriptions can usually be reissued by the doctor.
What exactly does a regulation “outside the normal” mean?
If the total prescription amount of 30 units is not enough, because If, for example, lipedema as well as lymphedema are chronic (i.e. permanently treatable) diseases and this can worsen again during a three-month break in therapy, the doctor may prescribe the MLD “outside of the normal”. The number of units is not limited and the prescriptions are usually issued as quarterly prescriptions. Such prescriptions require a special justification including an estimated prognosis of the course of therapy by the doctor.
Are the prescriptions a burden on the doctor's budget?
Whether a prescription burdens the doctor's budget or not always depends on the respective diagnosis code (ICD-10 code). For this purpose, the doctor has two diagnosis lists in which the respective diagnoses are precisely regulated. Especially serious illnesses and long-term damage (e.g. lymphedema) in stage 2 or 3 are out of the doctor's budget.
Unfortunately, many of those affected hear the doctor say that their prescription volume has been exhausted and that they therefore cannot prescribe an MLD. You automatically feel excluded.
My tip: Talk to the doctor openly about the topic and have the circumstances briefly explained to you. So you go home with precise information and don't feel in the dark.
What does a "long-term remedy need" mean?
Sufferers who are seriously or permanently ill usually need long-term treatment for at least a year or more. Depending on the diagnosis and severity, there is the possibility of automatically falling into the long-term remedy requirement. With the diagnoses listed, it is assumed that the severity and long-term nature are automatically given. An example of this is stage II lymphedema if the diagnosis group of the remedy catalog is LY2 or LY3.
For this purpose, the doctor also has a corresponding diagnosis list ("Appendix 2 to the Therapeutic Products Directive"), which states exactly which ICD-10 code is suitable for long-term medicinal products. There is no need to apply to the health insurance company for this and the prescription is automatically “budget-neutral”.
You can find Appendix 2 to the Therapeutic Products Directive here.
What are ICD-10 Codes?
This is the international statistical classification of diseases and related health problems. The diagnoses made on an outpatient and inpatient basis are officially classified on prescriptions and transmitted in encrypted form.
The ICD-10 code should always be indicated in the field provided on the therapeutic product prescriptions. This is important for clarifying the question of whether the MLD, for example, goes on the doctor's budget or is budget-neutral. This field is relevant for the examination offices of the health insurance companies and it is machine-readable.
What should an exactly filled out medication prescription look like?
At this Stars I'll show you what a long-term medication prescription for MLD can look like. Please note that this is an arbitrary example and is not a fixed template. The arrows show you what is important when it comes to the need for long-term remedies.
The following crosses are required:
- Prescription outside of the normal case (with the latest start of treatment)
- Home visit (YES or NO)
- Therapy report (YES)
- Indication key (LY2 or LY3)
- ICD-10 code with confirmed diagnosis
So it is worth taking a look at your next prescription and if you have any questions, please contact your doctor directly.