Question:
Adominoplasty vs. Panniculectomy coding &

My ins. has an exclusion for abdominoplasty. I had reapplied asking for a panniculectomy and was denied again. I noticed the cpt code was same on both procedures & surgeon office verified. Can someone point me to web site describing these two procedures as different and the cpt code for each? Thanks in advance    — lessofme170 (posted on September 16, 2003)

September 16, 2003
The CPT is the same. Description from my CPT book for code 15831: Excision, excessive skin and subcutaneous tissue (including lipectomy);abdomen (abdominoplasty)
   — Kara J.

September 16, 2003
I'm guessing there is a modifier that goes on the separate procedures to clarify it further. An abdominoplasty tightens miscles etc and panni does not - just strictly removes the roll of skin. At least that's what I have read and what my PS told me.
   — zoedogcbr

September 16, 2003
Thanks Kara. Sounds like it is the end of the line for me then since the codes are the same. The ins. book denied abdominoplasty but her letter denied the pannicluectomy and that particular cpt code. I'm scared to finance myself as the ins. book also says anything related to it in anyway will not be covered. Talk about a potential financial disaster..... snif....
   — lessofme170

September 16, 2003
Hi Teresa! You're right. Most ins.plans have exclusions for both of those procedures.I just had plastic surgery in July, and my surgeon coded it as an "abdominal reconstruction". I never got a chance to find out what the cpt code was-- sorry. Mention this to your surgeon. Maybe this can get it approved. Good luck! Oh, BTW,in this procedure the abdominal muscles are tightened also.
   — Karen A.

September 21, 2003
I just had a tummy tuck and breast lift 4 weeks ago. The panniculectomy only takes away the fat below the waist; an abdominoplasty tightens the muscles and takes away extra skin above and below the waist. My doc and hospital in Houston gives a discount for self-pay patients. I LOVE my new body!!! The money was well worth it!
   — Betty Todd