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Coding Help...

  1. Default Coding Help...
    Medical Coding Books
    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

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