Searching for a code to bill for a post-panniculectomy surgery? Get to know CPT code 15847 — a popular add-on code to 15830! Panniculectomy is a widely performed surgical procedure for removing excessive lower-abdominal skin. However, it doesn’t tighten a patient’s muscles.
Therefore, many surgeons perform abdominoplasty with this surgery to help patients achieve their desired look. In fact, approximately 170,110 tummy tuck procedures were performed in the U.S. in 2023, a 5% increase from 2022. The number continues to increase, but many plastic surgeons struggle with the coding part.
You might already be familiar with CPT 15847, but are you aware of its insurance coverage and documentation requirements? Let us break down what this code covers and how to use it accurately so you can get paid without any headaches!
CPT Code 15847 – Description
So, what exactly does this code cover? As mentioned in the intro, CPT code 15847 is an add-on code, specifically for 15830. It describes a surgical procedure during which a plastic surgeon removes excessive skin and subcutaneous tissue — the deepest layer of the skin mostly made up of fat cells and connective tissues — from a patient’s lower abdominal area (typically below the belly button).
To be more specific, CPT code 15847 refers to abdominoplasty. It is often performed on patients after their initial weight loss surgery, panniculectomy, to flatten their stomachs. In short, abdominoplasty is primarily performed for aesthetic purposes, helping patients get rid of protruding stomachs or loose or sagging skin. Therefore, it is considered a cosmetic code.
Scenarios Where CPT Code 15847 is Applicable
Here are a few applicable scenarios for CPT code 15847:
Removing Postpartum Overhanging Abdominal Skin
Let’s consider a basic scenario! Suppose a woman develops an ulcer under the apron — a pouch of loose skin or fat — due to constant friction and moisture in her skin folds. The overhanging skin is primarily due to her having four children via C-section.
Tired of the pain, discomfort, and unpleasant odor, she visits an experienced plastic surgeon in her area for a panniculectomy. After removing the excess skin from her lower abdomen, the doctor performs abdominoplasty (CPT code 15847) to tighten her abdominal muscles.
He then reports CPT code 15847 along with 15830.
Removing Excess Fat after Massive Weight Loss
Let’s assume a man struggles with mobility issues due to a pannus stomach — a condition where excess skin or fat hangs down from the abdomen. The primary cause? He lost 200 pounds through diet and exercise.
He visits his local outpatient surgery clinic, where the surgeon performs a panniculectomy to address his problems. After the procedure, the surgeon puts in extra effort to tighten the patient’s abdomen, helping him regain his confidence.
The billing team reports this additional procedure with CPT code 15847.
Removing Excess Skin & Fat Post-Bariatric Surgery Due to Chronic Skin Infection
Let’s consider another scenario! Suppose a man loses 160 pounds after bariatric surgery. However, he now suffers from intertrigo — an inflammatory skin condition that can lead to infection — due to his large, overhanging pannus.
He visits his nearest surgical center to address this issue. The surgeon evaluates his condition and performs a panniculectomy to remove excess skin. After that, at the patient’s request, the surgeon removes additional fat via abdominoplasty.
The healthcare provider reports CPT code 15847 along with 15830 to document these procedures correctly.
Applicable Modifiers for CPT Code 15847
Since CPT code 15847 is an add-on code, it does not typically require modifiers. However, you can apply the following modifiers to communicate additional information when billing this code with CPT code 15830.
Modifier 59
You can use modifier 59 with CPT codes 15847 and 15830 when these surgical procedures are distinct and separately identifiable from other services you have provided to the same patient on the same day.
However, insurance companies tend to scrutinize this code due to its misuse. If panniculectomy and abdominoplasty are distinct for a specific reason, for example, they were performed at a separate encounter or by a different physician, use one of the X{EPSU} modifiers.
Modifier 22
You can use modifier 22 if the surgery requires more work and time than expected.
Modifier 53
There are several risks and complications associated with plastic surgery. So, if you discontinued the tummy tuck procedure for any extenuating reason after administering anesthesia, including bleeding, infection, or persistent pain, use modifier 53.
Modifier 80
You can apply modifier 80 if an assistant surgeon is involved in the procedure.
CPT Code 15847 – Billing & Reimbursement Guidelines
You can follow these guidelines when reporting CPT code 15847:
Report CPT Code 15847 with a Primary Procedure
Since CPT code 15847 refers to an add-on procedure, you should never bill it separately. Always report it with a primary procedure, such as panniculectomy (CPT code 15830).
Maintain Complete Documentation
As you know, accurate documentation is essential for effective billing. Therefore, your patient’s records must include a detailed description of the procedure. These documents should be legible and readily available to the contractor upon request.
Understand Insurance Coverage Limitations
CPT code 15847 refers to abdominoplasty, which is considered a cosmetic procedure and, hence, is generally not deemed medically necessary. As a result, most insurance companies, including Medicare and Medicaid, do not cover it.
Inform Patients about Their Financial Responsibility
Our advice? Inform patients beforehand that their insurance plan will not cover this cosmetic procedure. Only proceed if the patient is ready to take full financial responsibility to avoid payment disputes or financial losses.
Summary
To summarize, CPT code 15847 is an add-on code referring to a cosmetic abdominoplasty. You can only use it with CPT code 15830. Although most insurance companies do not cover this CPT code, it is still important for documentation purposes.
Hence, we have provided a simple description of this code along with real-world scenarios so you can use it accurately. Moreover, we have also covered billing and reimbursement guidelines so you can avoid payment headaches and patient conflicts.
The easiest way to navigate coding challenges is to delegate the workflow to experts. Our plastic surgery billing services include CPT coding at the hands of AAPC-certified professional coders.
