AAPC - Back to school
Results 1 to 2 of 2

Thread: Coding Help...

  1. #1

    Default Coding Help...

    AAPC: Back to School
    Has anyone ever had to bill for gluteal implants that are not considered cosmetic. If so what CPT code was used for billing?


  2. #2


    What kind of situation would make the implants non-cosmetic?

    There aren't any other kinds of codes that state a non-cosmetic vs. medically necessary implant insertion for that. In this case, payment is probably going to be more diagnosis-driven than by CPT.

    Instead of the "standard" V50.1 for cosmetic reasons, use the diagnoses that causes your patient to require them - for example, perhaps your patient had some kind of soft tissue or bone cancer in that area and the implants are part of reconstruction process. While I'm fairly certain there's no code for acquired absence of a hiney, there are probably other codes, like history of ca or something like that.

    An example of this is when a mole is removed, more often than not, claims are denied because the removal is considered cosmetic. However, there are times when the mole is in a bad spot that is chafed, aggravated & subject to bleeding & infection. These conditions make it more of a medically necessary procedure vs. cosmetic and the diagnoses we report can make a huge difference.

    You may still have to appeal your claim, but at least it's closer to the mark than just stating "cosmetic" and hoping for the best.

    If your surgeon hasn't given you a suitable diagnosis to justify the medical reason for a gluteal implant, see if you can work together to document & get what's needed to show medical necessity.

    Leslie Johnson, CPC


Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.