Reconstructive codes

[LEXUS86985 21]

Does anyone have experience with the procedure codes?? I'm having the panniculectomy procedure 15830. The dr does not normally bill for facility codes but wants to bill as much as possible in order for me to get all of my money back from the insurance company. I have experience with procedures but I've never billed facility fees. I've asked a few people to help but so far they've been no help. Does anyone know what he can bill for in addition to the actual procedure??? I'm getting anxious because I'm waiting for these codes before we request the authorization!! Help?!?! Much thanks in advance!!

[Flylovesong 24]

I can provide you the various codes (although his surgical scheduler should be able to get them also), however I am on an loa from work due to surgery that I had on Monday. I will not be back into the office until Thursday next week (the 11th) if you can hang tight, I will have access to the coding book and can help you out.

[LEXUS86985 21]

Thank you so much!! This seems to be a unique situation. My sister in law works for my pcp and they referred me to this plastic surgeon. He doesn't normally do reconstructive work. But he's super nice and considers me family because of who referred me. His secretary knows nothing about coding at all.... He has a surgical suite in the office and usually doesn't bill for facility charges. I have to pay up front but he is trying everything possible so I get all my money back. I have so many people trying to get codes but it's been two weeks so far. I guess I'm just anxious.... All I need are the facility codes so we can submit for auth. I appreciate your help!!!! :-) I hope you're feeling well!!

[Flylovesong 24]

Ok, here is what the code 15830 encompasses:

Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniceculectomy.

The add on codes that can be performed with 15830 are:

15847 Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen (eg, abdominoplasty) (includes umbilical transposition and fascias plication)

This would be if he is going to relocate your belly button.

Any non-listed procedure that can be billed in conjunction with the above codes, would be billed under 17999 - unlisted procedure, skin, mucous membrane and subcutaneous tissue.

Lastly, if he plans on using liposuction, then 15877 -Suction assisted lipectomy; trunk (when performed in conjunction with code 15830) is the code that can be billed with the above procedures.

Hopefully this helps

[Sunshine4U 14]

Ok' date=' here is what the code 15830 encompasses:

Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniceculectomy.

The add on codes that can be performed with 15830 are:

15847 Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen (eg, abdominoplasty) (includes umbilical transposition and fascias plication)

This would be if he is going to relocate your belly button.

Any non-listed procedure that can be billed in conjunction with the above codes, would be billed under 17999 - unlisted procedure, skin, mucous membrane and subcutaneous tissue.

Lastly, if he plans on using liposuction, then 15877 -Suction assisted lipectomy; trunk (when performed in conjunction with code 15830) is the code that can be billed with the above procedures.

Hopefully this helps [/quote']

Flylovesong

Thanks for this information this is a common concern wondering if our respective insurance companies will take care of these types of procedures and how to approach them when they do.

Sunshine

[Flylovesong 24]

I can post the standard qualifying criteria for an abdominoplasty. This is the standard for many of the big insurers (Medicare, Medicaid, BCBS, Hap, etc...) give me a few minutes to get it together.

Many of you will be surprised at how easy it is to have some reconstructive procedures covered.

[Flylovesong 24]

Insurance provides coverage for Abdominoplasty/Panniculectomy when it is medically indicated to correct or relieve:

• a panniculus that hangs below the level of the pubis; AND

• the panniculus causes uncontrolled intertriginous dermatitis, skin ulceration, or necrosis that persists despite a documented 6 (six) month trial of conservative treatment under the direction of a qualified physician; AND

• The patient has a Body Mass Index (BMI) of less than 30. To calculate BMI, refer to: www.intmed.mcw.edu/clincalc/body.html. If the weight loss is the result of bariatric surgery, abdominoplasty or panniculectomy should not be performed until at least 18 months after the bariatric surgery.

Limitations

• Abdominoplasty or Panniculectomy for the purpose of minimizing the risk of hernia formation or recurrence is considered experimental and investigational and therefore, not a covered benefit.

• The procedure is limited to one procedure per member per lifetime. Required Medical Record Documentation

•Medical record documentation of the indications for surgery including, but not limited to, weight, weight stability, conservative treatment of skin conditions, etc.

•Physician oversight must be performed by a physician other than the physician performing the surgical procedure, such as the member’s treating physician.

[blondegal_ 1,028]

Flylovesong-

Do you know if skin removed from thighs is ever covered by insurance? I still have plenty of weight to lose but am already noticing extra skin on my inner thighs.

Thanks for the info!

[Flylovesong 24]

Tara-U

Unfortunately no. Insurance will pay for the tummy because it causes rashes which many times lead to infections. They will also pay for breast lifts if cellulitis or other major skin infections happen.

However, you may find that elective surgery for thighs and arms is pretty affordable if done in conjunction with a medically necessary procedure like a tummy. The hospital that I work at, it would cost approx $1200 (facility, surgeon and anesthesia) for the thighs when performed in conjunction.

[blondegal_ 1,028]

Thanks. What if you get rashes in the thigh area? I know I sound silly but I seriously have a lot of fat on my thighs. For years I've had to buy pants at least one or two sizes too big in the waist to fit my thighs. I can just imagine the skin not tightening up.

[Flylovesong 24]

I've never heard of an insurance authorizing a thigh lift. My girlfriend had it done and she is so happy she did it but it looked so painful. I have some loose skin but it tightens up nicely when I run (which I can't do because of my surgeries that I've had recently)

[ladyjordan 105]

^{great information...}

[LEXUS86985 21]

Thank you for those codes. I actually need codes that a surgical center would bill. We are only billing for the panniculectomy as a surgical procedure.... So I need codes we can bill for the surgical center. I know nothing at all about the facility side. I used to work for an insurance company and we would enter the authorization with the doctors procedures then just add the surgical center. The surgical center never added codes to the auth they just billed their own codes after the procedure. I've never seen what the surgical center billed for... Ex: supplies? Time in the room? I know so many people in the medical billing industry but so far no one has been able to help. Anyone out there have connections at a surgical center??? :-) HELP!!! Thanks everyone!!

[Flylovesong 24]

Those codes are what a surgical center would bill for. Any supplies would go out under the procedure code. Every supply has its own revenue or supply code based on supplier/manufacturer or even the facilities warehouse. A CPT (Current Procedural Terminology code) is a standard code for particular procedures across the board in terms of facility (surgical center/facility/hospital/ etc...).

If I were a surgical center/facility, and you had a panniculectomy, the CPT code would be the primary procedure performed. Everything that gets used such as sponges, sutures, clamps, etc... Along with lab work, medications and whatever else, would get billed along with the code. It's very hard to determine all the supplies that would be used because supplies are a patient by patient variable. Either way, supplies do not have CPT codes. The health system that I work for uses different supplies for different hospitals within the system. One site might use guardian brand sponges while another site might use Covidien sponges.