You will likely need TWO surgeons, in cooperation - the general surgeon to fix the hernia, and a plastic surgeon to do the abdominoplasty. But you MUST make sure there is a good reason documented for having the abdominoplasty - laxity of the abdominal wall which could lead to another hernia, or desire to avoid mesh.
This was from the day of my husband's surgery:
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 FUPA lift along the incision line that had to be made anyway.
And this was the post from robs' one year surgiversary post (damned ninja onion cutters ...) - has more details:
Despite being severely underweight until his 30s (6'2", 125-135 lbs, he has told me), due in no small part to his HUGE full sugar Coke (and cheeseburger) habit (3-5 Big Gulps-worth a day), by the time I met him when he was 46, he was up over 230 lbs; a few years later (probably not surprisingly, during the same time period I put on 50+ lbs immediately after we met, and became MO), he was up to at least 255. Right around the time I had my DS in 2003, Coke Zero came out, and I got him to try it. To his surprise, he found it tolerable (he couldn't STAND Diet Coke). (Somewhat annoyingly) in about the same time it took me to lose my first 35 lbs with my DS, he MOSTLY substituted Coke Zero for regular Coke and lost 30 lbs.
Everywhere else on his body, besides a remaining basketball-sized mound of intraabdominal fat, he was lean as could be - except, he had a rather significant FUPA, which really really bothered him. But he also had an umbilical hernia which was getting bigger and bigger, and was hurting - a headbutt from the cat and he would double over. And he also had two inguinal hernias. So eventually I got him back to the general surgeon who had repaired his inguinal hernia before (it re-tore, and the mesh in the first repair has always bothered him), and asked her whether it made sense to seek an abdominoplasty to tighten his abdominal muscles INSTEAD of using mesh to repair the umbilical hernia - he has and apparently even as a kid always had very lax abdominal muscles (like post-partum women and morbidly obese people get), due to separation/wideness of the linea alba (i.e., he has congenital diastasis recti) - his big belly was not just fat, but also the laxity of the musculature. She thought it might be possible, though she was dubious about getting it covered by insurance.
Did you say INSURANCE!?! Let me at 'em!
So we got Charles to a plastic surgeon, and he agreed to scrub in to the umbilical hernia and inguinal hernia repairs. And I wrote out what I wanted the two surgeons to write (as guidelines - I'm sure they tailored what they submitted to what THEY thought was appropriate), and we submitted. Keep in mind, this was with VA BCBS, and not under the more consumer friendly CA rules. While preparing for the procedure, Charles deliberately lost another 30 lbs or so - he was at around 185 by the time he had surgery - to ease the pressure on his belly (and of course for his health). And he quit smoking.
And although they took their sweet time, and I had to make a call to the person reviewing the request for precertification myself 2 days before the procedure, it was approved!
So here is the interesting part. Abdominoplasty is a single CPT code that covers THREE procedures - (1) repair of the diastasis recti (which is really all we were seeking), (2) lipectomy (removal of excess fat); and (3) excision of excess skin. So the procedure went something like this:
- General surgeon laparoscopically fixed the torn old hernia (from the backside of the lower abdominal wall)
- Plastic surgeon opened up a lower abdominal incision from hip to hip, just above the pubes, and undermined the skin above and below
- General surgeon fixed the new inguinal hernia on the other side from under the skin
- General surgeon removed his umbilicus and closed the hole in the abdominal wall
- Plastic surgeon did the diastasis repair (gave him an internal corset)
- Plastic surgeon cut away some of the excess skin and fat on both sides of the incision, giving him a FUPA lift in the process (!!)
- Plastic surgeon closed.
So he got his hernias fixed and got a little "enhancement" as a bonus as well.
