Mountain State Medical Policy Bulletin |
Section: | Surgery |
Number: | B-35 |
Topic: | Abdominoplasty and Panniculectomy |
Effective Date: | December 24, 2007 |
Issued Date: | December 24, 2007 |
Date Last Reviewed: | 12/2007 |
Indications and Limitations of Coverage
Abdominoplasty ("Tummy Tuck") is a surgical procedure which tightens a lax anterior abdominal wall caused by diastasis recti (the separation of the two rectus muscles along the medial line of the abdominal wall) and removes excess fat and abdominal skin. This procedure reduces the protruding abdomen and provides an overall improvement in the person’s shape and figure. Panniculectomy/abdominal lipectomy is the surgical resection of the overhanging “apron” of redundant skin and fat in the lower abdominal area. A panniculus or fold is often seen in men or women who have had significant weight loss or in morbidly obese patients. Report procedure code 15830 when performing a panniculectomy. Report procedure codes 15847 and 15830 when an abdominoplasty is performed with a panniculectomy. Procedure code 15847 should only be reported with procedure code 15830. When an abdominoplasty is performed without panniculectomy, report procedure code 17999. Payment will be made for the following potentially cosmetic procedures as reconstructive surgery when performed for the reasons indicated: Abdominoplasty ("Tummy Tuck")
Panniculectomy
*Conventional treatment may be defined as treatment with oral antibiotics, topical anti-infective medications and adequate hygiene. Non-Covered Services
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15830 | 15847 | 17999 |
1. Blue Cross and Blue Shield of North Carolina, SUR6170 2. Blue Cross and Blue Shield of New York, 7.01.53 3. Anthem Blue Cross and Blue Shield, SURG.00048 4. Highmark Blue Cross Blue Shield Medical Policy S-28 (Cosmetic Surgery vs. Reconstructive Surgery) |
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