procedure codes

does anybody have any procedure codes for plastic surgery? i need as many as u can give me for tummy tuck, arms, breast lift, thighs, butt.... I am getting a new job and my new insurance isnt as good, i dont think, so im trying to find out if they cover certain procedures, or if i should keep my old insurance. i have to check with both insurance companies asap to make my decision. thanks for your help. camille

thats a great question, I would like to know too.

Hello all of my Handsome and Gorgeous AMOS Brothers and Sisters I thought I would share my reconstructive surgery insurance letter that I wrote. This may help some of you who are looking for something to reference for reconstructive surgery insurance approval letter writing. I was approved for tummy tuck, thigh lift with no problems after I changed insurance from UHC EPO to Independence Blue Cross. Arm lift, breast lift, hip lift, buttock lift was approved after appealing once with Independence Blue Cross. Independence Blue Crossm PPO out of PA approved me for everything. I paid 500.00 for all of the surgeries and that was my annual out of pocket. I had UHC EPO a year prior and they approved WLS no problem or questions asked,but I fought with them for months and got nothing approved prior to Independence Blue Cross PPO. I also had major issues with the skin (rashes and infections) and back, neck, and shoulder pain and 260 pages of doctors notes. Be forwarned some insurance companies will not pay for reconstructive surgery (never call it plastics with insurance or it will be denied) no matter what kind of medical documentation or medical problems you have as a result. So please do not think that insurance approval is a given. I was truly blessed by God that my insurance policy did have a Reconstructive Surgery after Weight loss policy written into it. P.S. Not that it matters, but this letter is very very very old so the stats are not accurate for my weight now. I am now weigh 147 with a loss of 158 pounds since 06/06/02 BMI 23. Good Luck to you all.God Bless. Teena A [email protected] Aol Messenger: Swexan2425 Yahoo Messenger: Skyedancer4u NEVER LET PEOPLE, PLACES, OR THINGS STAND IN YOUR WAY OF FULFILLING YOUR GOALS AND LIVING OUT YOUR DREAMS. June 26,2003 Member Name: Member Id: Member Date of birth: Group number: Member address: Member phone and fax number: Member email address: Re: Requesting Expedited Approval for Excision of Excess Skin after Massive Weightloss - Medical Necessity Predetermination Dear Patient Care Management Department- Cosmetic Review Team: I am writing this letter to request expedited approval for medically necessary surgical procedures listed below: Abdominoplasty (extended to the lumbar) Cpt Code: 15831 Buttock Lift 15835 Brachioplasty Cpt Code: 15836 Mastopexy Cpt Code: 19316 Thighplasty Cpt Code: 15832 Hip-plasty Cpt Code: 15834 I am not requesting these surgeries for cosmetic reasons. These surgeries are reconstructive following massive weight loss per the American Society of Plastic Surgeons and The American Medical Association. Per customer service representatives with IBC there are no exclusions or preexisting clauses on my policy as long as procedures are medically necessary or will correct functional impairment. Loss of excessive weight may lead to redundant skin. Excision of redundant skin after weight loss in areas such as, but not limited to, the abdomen, lumbar region, arms, and/or thighs is medically necessary for intertrigo, monilial infestations, and/or panniculitis that have failed to resolve with conservative measures. Abdominoplasty is a surgical procedure used to alter the abdomen by removing excess skin and/or fatty tissue and tightening a lax anterior abdominal wall. Potential complications from abdominoplasty include blood or serum collections beneath the flap, infection, tissue loss, and protrusion of the abdominal wall between the left and right rectus abdominis muscles. Abdominoplasty and excision of redundant skin after weight loss is medically necessary and is performed for the treatment of the following conditions: suprapubic intertrigo, monilial infestations, and/or panniculitis when conservative treatment measures have failed. Excision of redundant skin after weight loss performed for all other indications is considered cosmetic. If cosmetic surgery is included in a group benefit contract as a covered service, the service is provided to members in such groups in accordance with the terms of the contract. I had gastric bypass surgery June 6, 2002 and have successfully lost 137 pounds. I weighed 305 pounds (BMI 47.4) the day of surgery and now weigh 168 pounds (BMI 26.3). Although I have lost the weight and feel better about myself and am healthier I am now left with 25 pounds of excess skin all over my body. The excess skin has affected the physiological function of my abdomen, lumbar, buttocks, arms, thighs, and breasts. The excess skin has also caused me functional impairments and quantifiable medical problems, such as uncontrollable and untreatable fungal dermatitis, folliculitis, intertrigo and suprapubic intertrigo, yeast, fungal, and bacterial infections. I have problems with hygiene as it is very difficult to keep clean between the skin folds and I often take three to four showers a day and still never really feel clean nor am I odor free. Even though the surgeries I am requesting are considered reconstructive surgeries by The American Society of Plastic Surgeons and The American Medical Association some health insurance companies label them as cosmetic surgeries. I just wanted to point out to you that my policy states that cosmetic surgery is covered if it is medically necessary and if it is being performed to correct a functional impairment caused by a covered disease, injury, or congenital birth defect. All of my doctors treating me have stated and documented the medical necessity for me to have these procedures performed. The following are functional impairments as a result of the excess skin: intertrigo, suprapubic intertrigo, fungal dermatitis, folliculitis, rashes, yeast and bacterial, infections, hygiene issues- I can never keep skin folds clean, back pain, neck pain, shoulder pain, problems lifting things over 10 pounds, problems sitting for long periods of time, problems standing for long periods of time. The covered disease was Morbid Obesity. The treatment for Morbid Obesity was gastric bypass. The excess skin is a result of treatment (gastric bypass) of a covered disease (Morbid Obesity) - which qualifies me for reconstructive surgery. In addition, as stated below, reconstructive surgery is done to improve function, as well as approximate a normal appearance. The pain is becoming stronger with each day in regards my abdomen, lumbar, buttocks, arms, thighs, and breasts. The excessive skin is so great that I am experiencing degenerative disease in my lower back. My excessive skin folds on my abdomen, lumbar, buttocks, arms, thighs, and breasts are a direct result of the extreme weight loss of 137 pounds. It is my understanding that the removal of the skin can take away the folds that trap moisture to prevent the infections. A requirement of the gastric bypass surgery is that I must keep up my exercise to be successful. Exercise causes me great pain because of the excess skin constantly rubbing together. The more I exercise the more I sweat and as a result of the sweat (trapped moisture) the rashes and infections are increasing and becoming worse. This has resulted in me becoming less active. In addition, please note that these functional impairments of the skin cannot be managed with non-surgical methods. First, you cannot do anything about the excessive skin without surgery. Second, the rashes and infections caused by the skin rubbing together between my abdomen and pubic area, thighs, breast, and arms cannot be cured without taking what is causing the rubbing away (the skin). The creams and lotions have done nothing the last seven or eight months to treat my condition. Additionally, without removing the skin, we cannot correct the abnormalities/deformities that have been created as a result of the treatment of the morbid obesity. I have been treated by Dr. Mary Fleshchli since January 2003 and have been prescribed Loprox and Niacin cream, and Zeosorb powder for my rashes, intertrigo and suprapubic intertrigo, fungal dermatitis, folliculitis, and yeast,fungal, and bacterial infections. However, since the excess skin constantly rubbing together causes them to get infected on a daily basis they never go away or heal. I am basically raw from every movement that I make as I have excess skin all over my body. The medications do not help as the excess skin still remains. Pictures have been included for your review however because I am dark skinned it is quite difficult to see rashes, intertrigo and suprapubic intertrigo, fungal dermatitis, folliculitis, and yeast and bacterial infections in pictures however they can clearly be seen in person. Walking, standing, or sitting for long periods of time, lifting things over ten pounds, bending, reaching, carrying and stooping are all very difficult as the pressure that the excess skin places on my already curved spine and extremities is quite painful and makes being active very difficult. I am in constant pain and currently am on Bextra, Soma, and Elavil medications for pain relief. I often have to seek assistance from family and friends with household chores that involve lifting, carrying, reaching, moving things or assistance with things that require me to stand up for long periods of time. I also have problems with exercising as the skin is constantly in the way and cause me problems with range of motion. As a result of the excess skin on my breast I have great difficulty with giving my self-breast exams. This worries me greatly as Breast Cancer runs in my family and because of all of the excess skin on my breast I can not feel the difference between excess skin or breast tissue or a legitimate lump. I recently had a breast exam from my OB-GYN -Dr. Traci Nivens, and she even had difficulty giving me a breast exam because of the excess skin on my breast. I also have rashes and infections under my breast caused by the constant rubbing of excess skin against my abdomen. She has also noted in her letter the difficulties I have with performing sexual intercourse due to extreme pain caused by the excess skin in my thigh and pubic area. My pannus (excess skin from abdomen) hangs below my pubic area and constantly rubs it all day long causing open sores that bleed. My arms have three to four inches of excess skin hanging that constantly rubs my sides and causes open sores that bleed. My breast hang down to and constantly rubs my abdomen causing open sores that bleed. My thighs have 5 to 6 inches of skin that hangs down and rubs constantly with every movement I make causing open sores that bleed. I also have severe back pain, neck pain, shoulder pain, and tingling in my fingers and arms. The excess skin hanging off of my body is adding unwanted pressure to my spine and causing me various problems with movement. I have been seeking Chiropractic adjustments and physical therapy for more than seven months, however because of the excess skin hanging off of my body my Chiropractor - Dr. Sandra Sullivan states that the pain will persist until the excess skin is removed. She believes that my back, neck, and shoulder pain will be improved once the skin is gone. I am seeking approval for the following surgeries based on medical necessity: Abdominoplasty (extended to the lumbar) Cpt Code: 15831 Buttock Lift 15835 Brachioplasty Cpt Code: 15836 Mastopexy Cpt Code: 19316 Thighplasty Cpt Code: 15832 Hip-plasty Cpt Code: 15834 The codes that are related to my signs and symptoms are below Candidiasis (ICD-9: 112.89, 112.9) Permanent overstretching of the anterior abdominal wall (ICD-9: 928.84) Large or long abdominal panniculus (ICD-9: 278.1) following weight loss in the treatment of morbid obesity and resulting in the Difficult ambulation (ICD-9 724.8). Structural defects of the abdominal wall (ICD-9 701.8/708.9) Uncontrollable intertrigo (ICD-9: 695.89) Crease dermatitis, (ICD-9: 692.9) Large overhanging pannus (ICD-9: 701.8) Macromastia (ICD-9: 611.1) Ptosis of the breast (ICD-9: 611.8) Chronic breast pain (ICD-9: 611.71) Lower back pain and Postural backache (ICD-9: 724.2) Upper back (ICD-9: 724.1) Neck (ICD-9: 723.1) Shoulder pain (ICD-9: 719.41) Skin rashes (ICD-9:682.2, 682.3) Pressure sores (ICD-9:707.0) Dyspareunia (ICD-9:625.0) Pelvic pain (ICD-9: 625.9) The actual physiologic functions affected by excess skin Intertrigo and Suprapubic Intertrigo Fungal dermatitis Folliculitis Rashes Yeast/bacterial/fungal infections Hygiene issues- can never keep skin folds clean Back pain Neck pain Shoulder pain Problems lifting things over 10 pounds Problems sitting for long periods of time Problems standing for long periods of time Problems walking for long periods of time Problems exercising Problems taking care of difficult household chores without assistance Problems bending and stooping Problems reaching Problems carrying Sexual Dysfunction and pain because of excess skin Tingling in arms and fingers Dr Patrick H. Pownell is the plastic surgeon who will be performing the procedures as soon as approval is given. He is an In-Network surgeon and we are patiently waiting for your approval so that we can proceed with surgeries before fall semester in college starts for me August 25th. His contact information is listed below. I am requesting the insurance company to make a "good faith" review of this request. I ask that you review all medical documentation included and that you look at all of my medical issues, and view photographs before a determination is made. The photos do no justice in showing the abnormalities in my skin, as I am dark skinned. I am available to fly to your location and appear in person if you need to see me to have a better idea of how the excess skin is affecting my health. I ask that you approve these surgeries based on the terms and conditions on my policy, my doctor's recommendation and medical necessity. These surgeries are beneficial to restore physiologic function and correct functional impairments within my epidermis, dermis, joints, and muscles. There are no exclusions in my policy that would eliminate me from having the skin surgically removed from my abdomen, lumbar, buttocks, arms, thighs, and breasts to allow me to live free of pain and functional impairments. The sooner we hear from you, the sooner my surgeries can be scheduled. I thank you in advance for your assistance in a timely manner. Sincerely, Teena A Treatment of Redundant Skin after Massive Weight Loss Recommended Criteria for Third-Party Payer Coverage Background: The American Society of Plastic Surgeons (ASPS) is the largest organization of plastic surgeons in the world. Requirements for membership include certification by the American Board of Plastic Surgery. ASPS represents 97% of the board-certified plastic surgeons practicing in the United States and Canada. It serves as the primary educational resource for Plastic Surgeons and as their voice on socioeconomic issues. ASPS is recognized by the American Medical Association (AMA), the American College of Surgeons (ACS), and other organizations of specialty societies. Definitions: Morbid obesity is defined by a patient weighing at least 100 pounds over the ideal body weight or more than twice the normal weight for height. It is estimated that as many as nine million people in the United States suffer from morbid obesity. The death rate may range up to twelve times that of non-obese persons of the same age and sex. Associated medical conditions include coronary heart disease, hypertension, diabetes mellitus, osteoarthritis, respiratory distress, gall bladder disease and psychosocial incapacity. Improvements in the surgical correction of morbid obesity via gastric partitioning procedures as well as more effective non-surgical diet regimens have allowed increasing numbers of morbidly obese patients to undergo successful and sustained massive weight loss. While the medical/health benefits of massive weight loss are obvious, different problems may arise as a result. Massive weight loss can lead to extensive redundancy of skin and fat folds in varied anatomic locations causing functional problems. These areas include medial upper arms, breasts (male and female), the abdomen and medial thighs. Redundant skin folds predispose to areas of intertrigo, which can give rise to infections of the skin (fungal dermatitis, folliculitis, subcutaneous abscesses). Commonly affected areas are the overhanging pannus of the lower abdomen and beneath ptotic breasts. Constant rubbing together of medial thigh folds can cause areas of chronic irritation and infection as well. Excessive redundant folds of skin and fat can also cause difficulty of fitting into clothing, interference with personal hygiene, impaired ambulation and the potential of psychosocial concerns of a disfigured appearance. Surgical procedures to correct skin redundancy include panniculectomy with or without abdominoplasty (CPT 15831), mastopexy (CPT 19316), upper arm brachiocoplasty (CPT 15836), thighplasty (CPT 15832) and hip-plasty (CPT 15834). Cosmetic and Reconstructive Surgery: For reference, the following definition of cosmetic and reconstructive surgery was adopted by the American Medical Association, June, 1989: Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self esteem. Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. It is generally performed to improve function by may also be done to approximate a normal appearance. Indications Resection of redundant skin and fat folds is medically indicated if panniculitis (ICD-9 729.39) or uncontrollable intertrigo (ICD-9 695.89) is present. Chronic or recurrent skin infections may occur. A large overhanging pannus (ICD-9 701.8) may cause lower back pain (ICD-9 724.2) and interfere with ambulation and personal hygiene. In long standing panniculitis, lymphedema (ICD-9 457.1) and skin abscesses (ICD-9 682.2) may be present. Umbilical hernias (ICD-9 553.1) may be associated with a stretched umbilicus in the pannus. Ventral hernias (ICD-9 553.2) from previous abdominal surgery including gastric partitioning procedures may be present and require repair at the time of panniculectomy and abdominoplasty. In female patients with ptotic breasts after massive weight loss, macromastia (ICD-9 611.1) may be present and associated with postural backache (ICD-9 724.2), upper back (ICD-9 724.1), neck (ICD-9 723.1) and shoulder pain (ICD-9: 719.41). Intertrigo and related dermatitis may also be present. Reduction mammoplasty (19318) is indicated in these patients. If ptotic breasts are not enlarged but consist mostly of redundant skin and fat, mastopexy (CPT 19316) may be performed for males and females. Resection of redundant upper arm and thigh tissue is performed to improve the patient's comfort and appearance. Redundant thigh tissue may extend posteriorly and involve the buttocks and inferior gluteal regions. Procedures: Panniculectomy is the surgical resection of the overhanging "apron" of redundant skin and fat in the lower abdominal area. The redundant skin and fat may continue laterally across the hips and lower back. If this is symptomatic, correction by excision of excess tissue in these regions may be medically necessary (CPT 15834). Umbilical or other abdominal hernias may also be present and should be repaired. If significant folds of redundant skin in fat are present in the upper abdomen and signs and symptoms of functional abnormalities are present, an abdominoplasty (CPT 15831) may be indicated with the panniculectomy. Massive weight loss can cause significant ptosis of the breast (ICD-9 611.8). If medically indicated symptoms and signs of breast enlargement are present in the female patient, a bilateral reduction mammoplasty (CPT 19318) is indicated. Ptosis of the breast in male patient requires correction by subcutaneous mastectomy (CPT 19140) with skin resection and nipple areolar repositioning. Ptosis of the female breast without breast enlargement can be corrected by mastopexy (CPT 19316). In the thigh regions, excessive skin and fat is excised using various incisions to provide for direct removal of the redundant tissue with longitudinal or diagonal incisions extending to and sometimes including the inguinal region. The thighplasties (CPT 15832) are usually performed on the medical surface of the thighs, however, can be continued to the posterior inferior gluteal and buttock regions if indicated. In the arms, a brachioplasty (CPT 15836) is performed via an elliptical excision along the medial border of the upper arm. Documentation: Justification for the resection of skin and fat redundancy following massive weight loss should be documented by the surgeon in the history and the physical, and should be included in the operative note. In the abdomen, this consists of the probability of relieving the clinical signs and symptoms associated with the abdominal pannus, diminished abdominal wall integrity, including back pain, recurrent intertriginous dermatitis, poor hygiene and pressure of hernias. For the breast, it should be based on the presence of macromastia or ptosis in females. For the male patient, the presence of ptotic breast skin and nipples should be documented. Photographs: Photographs are usually taken to document pre-operative conditions and aid the surgeon in planning surgery. In some cases, they may record physical signs. However, photos do not substantiate symptoms and should only be used by third-party payers in conjunction with the patient's history and physical examination. It is the recommendation of ASPS that photographs be taken when the patient is in an upright position. The patient, however, must sign a specific photographic release form and strict confidentiality must be honored. It is the opinion of ASPS that a board-certified plastic surgeon should evaluate all submitted photographs. Position Statement: It is the position of the American Society of Plastic Surgeons that resection of redundant of skin and fatty tissue following massive weight loss is reconstructive when performed to relieve specific clinical signs and symptoms. Surgery to resect redundant skin is performed to relieve clinical signs and symptoms related to abdominal wall weakness and panniculitis; to relieve signs and symptoms when macromastia and/or ptosis is associated with this in female patients; and for male patients with signs and symptoms of ptotic breast skin. The resection of other areas of redundant skin and fat, specifically of the upper arm and thighs, may be indicated for cosmetic reasons. References: Davis, T. S. "Morbid Obesity." Clinics in Plastic Surgery, 11(3):517, 1984. Guerrero-Santos, J. "Brachioplasty." Aesthetic Plastic Surgery, 3:1, 1979. Hallock, G. G. "Simultaneous Brachioplasty, Thorachoplasty, and Mammoplasty." Aesthetic Plastic Surgery, 9(3):233, 1985. Hauben, D. J. "One Stage Body Contouring." Annals of Plastic Surgery, 21(5):472, 1988. Palmer, B. "Skin Reduction Plasties Following Intestinal Shunt Operations for Treatment of Obesity." Scandinavian Journal of Plastic and Reconstructive Surgery, 9:47, 1975. Savage, R.C. "Abdominoplasty Following Gastrointestinal Bypass Surgery." Plastic and Reconstructive Surgery, 71(4): 500, 1993. Zook, E.G. "The Massive Weight Loss Patient." Clinics in Plastic Surgery, 2(3):457, 1975. Prepared by the Socioeconomic Committee approved by American Society of Plastic Surgeons Board of Directors, June, 1996

I was recently approved for a TT. through BCBS of Alabama. I received my copy of the letter sent to the PS. The procedure code is:15831 and the description of the code is: Excision, Excessive Skin and Subcutaneous Tissue (Including Lipectomy) to include liposuction. My PS said this procedure is a total Abdominaplasty. I am scheduled to have PS on Wednesday, March 10 and I had WLS on March 12, 2002. I am almost 2 years post-op and I feel like I am where I am suppose to be. If anyone can tell me actually how much weight you will lose from this procedure. I want to lose about 12 more pounds for my personal goal and I think I will probably do that. I am excited and scared all at the same time. I just have one month from today and I will be a totally different individual. Thanks Jacquelyn