Wiki Liposuction for ALT flap debulking

[HThompson77]

I have a physician who placed an ALT flap on a patient' foot/ankle to cover an open non-healing wound. 9 months later the flap is healthy and ok but the patient is unable to wear many kinds of shoes due to excess bulk in the flap. Our surgeon used S.A.F.E. Liposuction and a little bit of cutting to remove excess bulk from the flap to help the patient fit into shoes better. Since this wasn't cosmetic and was a function problem of reconstruction it should be covered by insurance but the provider didn't do a prior authorization and is now wondering what CPT code to use. The liposuction codes don't have RVU values and are not paid by any insurance companies in our area. 15620? even though it was mostly liposuction? Other suggestions?

 

[strader]

When I researched the liposuction code I noticed it is zero RVU also but then saw it is Status R. My network is not working correctly at the moment so not sure what R means but our local MAC is usually helpful if you call and see what it means possibly restricted and they will tell you how to bill appropriately so your patient can wear his shoes.

 

[ritecode]

in 2020 there are no RVU's either. I have heard that a patient did appeal a Medicare claim for treating lipedema with tumescent, lymph-sparing liposuction (~2017)
and was reimbursed (2 appeals). I don't know the specific carrier.

To be considered reconstructive liposuction must be illustrated and documented to: Improve function or mobility (restriction of movement), restore to a normal appearance (not improve appearance), improve the Quality of Life (QOL) of the patient, and there are no comorbidities precluding treatment (i.e., vascular problems). Improving psychological well-being does not quality as reconstructive and should not be used.

To be reimbursed by a carrier the procedure must be considered NOT experimental and investigational, or unproven. Most carrier denials will use this objection and I have additional literature/research addressing this issue if you're interested.

Be sure to include before and after photos to illustrate decreased functionality and mobility.

It will be on a case by case basis. Good luck in the future.