Panniculectomy and redundant skin surgery in massive weight loss patients: current guidelines and recommendations for medical necessity determination.
There is certain insurance coverage criteria for panniculectomy and redundant skin surgery that every plastic surgeon participating in the surgical treatment of massive weight loss patients should be familiar with to accurately document and present the clinical findings of their patients. This article reviews the medical necessity guidelines used by most third-party payers for panniculectomy in massive weight loss patients after bariatric surgery. In addition, insurance coverage criteria for redundant skin surgery and panniculectomy recommended by American Society of Plastic Surgeons (ASPS) for third-party payers were reviewed. Although the criteria used by third-party payers are conceptually similar to those recommended by ASPS, in practice they are harder to meet by most weight loss patients. This discrepancy leads to a group of denied patients who would otherwise be authorized for plastic surgery after massive weight loss, when actual ASPS recommendations are taken into consideration. Furthermore, our search demonstrated that there are no established criteria or guidelines used for different body parts such as inner arms and medial thighs, other than the pannus among third-party payers. This review article points out to the fact that there is a need for development of new set of guidelines for those sites and for modification of current guidelines for medical necessity determination of panniculectomy used among third-party payers, according to actual ASPS recommendations.
Gurunluoglu
Raffi
R
Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences, Denver, CO 80204, USA. raffi.gurunluoglu@dhha.org
D000328:Adult; D050110:Bariatric Surgery; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D015187:Lipectomy / Q000191:economics*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000191:economics*; D050151:Subcutaneous Fat / Q000601:surgery; D015431:Weight Loss