My husband is in surgery, getting insurance-paid hernia repair AND an abdominoplasty. The coding for abdominoplasty is a cosmetic code that covers THREE procedures: diastasis recti repair, fatty tissue removal and skin fold (panniculus) removal. He only needed the diastasis repair, because closing the diastasis would make the umbilical hernia repair not require mesh, but
there is no CPT code for JUST a medically necessary diastasis repair. Don't ask me why - the reconstructive plastic surgeon didn't know either. I had to coordinate the insurance submissions from the general and plastic surgeon, to make sure they went in
together, including giving the general surgeon a "script" of words to use in her progress notes for the insurance submission that indicated that the PS's work was reconstructive when done in conjunction with her umbilical repair. I had to call the insurance company repeatedly to make sure the precert people UNDERSTOOD that there was no way to code the diastasis repair alone, and that in this case, the abdominoplasty was NOT cosmetic. They dawdled, but they approved it Friday night. He's in surgery right now.
AND - PS said, when he marked him up this morning, that since the abdominoplasty was approved, and it includes the skin excision, he's going to get a little PUFA lift along the incision line that had to be made anyway.