Code 15830?

I was told by Cigna I was approved for code 15830 when i look this up it is such a general listing...I was told by my surgeon we would try for belt lipectomy first then at least admonoplasty.  Any ideas if I was approved based on this code what procedures could be done? Any help greatly appreciated! 

http://www.plasticsurgery.org/medical_professionals/health_p olicy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID =18091 There is a link to the page I had found that gives the CPT code description.. It was an approval for a panniculectomy, or skin removal, can include a lipectomy. You weren't approved for the "tummy tuck" though. When I was approved for both, I had an approval for both codes, 15830 and 15847 which is the muscle tightening, moving the belly button, etc.. But you were approved for the skin removal part! congrats!

The important thing here is to ask your surgeon's office what procedures they will do with this approval.  I believe sometimes surgeons may only get approval for the panniculectomy but will do the tummy tuck.  But they get the approval for what they think the insurance company will pay for.

I am totally confused, i know i should be happy but all the surgeons office put down was 15830. I wanted more, admoplasty, and belt lipectomy....Cigna says they will have to resubmit everything if that is what I want..Does it sound like a slack surgeons office???

no, most surgeons won't even submit for a panniculectomy. .. because they are rarely covered. And usually getting approved for  a tummy tuck is unheard of.. How i did, is beyond me. .but i wont complain.. They only submitted for the panniculectomy because they don't want to "push" the issue, and get you approved for the part that they see being approved.. They can try to submit for the code 15487 (i think that was it) for the adominoplasty seperate I would think ? and it not bother your approval already? im not sure.. but seriously its RARE to be approved for the other codes.. and not many get the approval you got.

I was approved for the 15830.  Is that good or bad?

Let me give you a little background on the coding thing. The procedural codes 15830 & 15847 came out in the CPT revisions in 2006 and replaced the preexisting code 15831. These changes were brought about to clarify exactly what was (and was not) supposed to be included as part of the procedure for insurance coverage and arose after the Amer. Society of Plastic Surgery sat down with CMS to clarify the issue. CPT 15830 is for panniculectomy.  This is the only code that applies for insurance coverage for trunk procedures. There is no code for a belt-lipectomy procedure to include the posterior skin resection. This 15830 code specifically excludes skin/fat excision above your hanging pannus, treatment of the mons, plication of the muscle, liposuction, or reposition of the belly button. CPT 15847 is for cosmetic abdominoplasty. There are no RVU's assigned for this code (the $ the feds have associated with it) and it's strictly for tracking purposes. Insurers pay $0 on it. It includeds all the other elements not associated with 15830. It is not a code you'd submit for preauthorization or billing to a payor, although it would go alongside 15830 in your charges. The clarification came about after much confusion with the old code 15831, which was meant to apply to a panniculectomy but didn't specify exactly what it was. It lead to a number of problems with physicians balance billing the patients the cosmetic portion of the case and having insurers or patients claim all manuevers were included in the global descriptor and could not be billed for. This became an issue in recent years with the popularity of weight loss surgery when these patients began showing up en mass.

So are you saying it is up to the Surgeon what they will do with code 15830 approval?

To some extent. Anything done beyond the language of the 15830 CPT and not charged for is at your surgeons discression. They've no obligation to, nor should it be assumed they will perform other elements that would  be considered part of the cosmetic code. Many times I (and others) will do somewhat more, particularly in re. to repositioning the belly button. Keep in mind though that each additional move (more disection ,plication of the muscles, etc...) adds more time and potentially more morbidity to these surgeries on an operation that already pays fairly poor for insurance reimbursement and has high complication rates.