Plastic and reconstructive surgery medical billing is more complex than other specialties. Most of the time, cosmetic procedures are non-reimbursable by insurance companies (Medicare, Medicaid, and other private payers). This issue mostly arises due to insufficient supporting documentation justifying the medical necessity and appropriateness of the performed surgical procedure.
If you are tired of the rejected claims, why not outsource plastic surgery billing services to professionals, like MediBillMD? But before that, here’s a comprehensive guide to help you understand the most commonly used CPT codes for plastic surgery. So, without further ado, let’s get started!
Most Common Plastic Surgery CPT Codes
Discussed below are the commonly used plastic and reconstructive surgery CPT codes:
Reconstructive Surgery CPT Codes for Rhinoplasty
CPT Code 30400 – Primary Rhinoplasty, Nose Shape Repair or Change
A patient who has not had surgery before arrived at the doctor’s office. They complained about the appearance of their nose because it has a drooping and bulbous nasal tip, making it difficult to breathe.
A primary rhinoplasty procedure was rendered by the surgeon to reshape the nasal tip by modifying the alar cartilage to improve its projection. Besides, the provider elevated the nasal tip for better airflow, which also enhances the nasal profile.
Plastic surgery CPT code 30400 will be used to bill the services. The code covers the surgery on the alar (tip) cartilages, lateral (side), nasal tip elevation, or all of these.
CPT Code 30410 – External Nose Bony Portion Surgery
You may report this common plastic surgery CPT code if the surgeon renders a surgical procedure on the bony portion of the external nose with surgery on alar cartilages, lateral cartilages, and/or nasal tip elevation.
This procedure can benefit patients with prominent nasal bumps and deviated septum causing significant nasal obstruction. For instance, a surgeon encounters a patient with all the visible physical conditions and complaints of chronic sinus congestion, snoring, and difficulty breathing through the nose. Thus, the physician may recommend a CPT 30410 surgical procedure as the treatment plan to ease the patient’s condition.
CPT Code 30420 – Septal Repair
Consider a patient who has a severe nasal obstruction with frequent nosebleeds, breathing difficulty, and chronic sinus congestion because of a deviated septum. As a result, the surgeon performs a septoplasty that involves procedures to correct the septal deviation, such as cartilage grafts and septal resection. Thus, reconstructive surgery CPT code 30420 will cover these care services.
Plastic Surgery CPT Codes for Breast Surgery
CPT Code 19316 – Mastopexy
This reconstructive surgery CPT code is to bill for mastopexy, also known as a breast lift. It is a surgical procedure to remove excess breast skin and tighten the surrounding tissue.
Let’s consider a scenario to understand this code! If a patient encounters a physician with breast ptosis or sagging due to weight loss and complaints about severe shoulder and back pain. The surgeon may decide to perform the breast lift procedure to enhance breast shape and support and minimize the physical symptoms.
CPT Code 19318 – Breast Reduction
What if a woman encounters a healthcare physician with persistent and severe breast pain and discomfort? As a result, to rule out cancer, the provider orders mammography. The findings reveal multiple areas of microcalcifications in the right breast and put the patient at risk of cancer.
In many scenarios, microcalcifications are considered benign. However, their presence suggests potential malignancy. Therefore, the surgeon decides to perform a breast reduction surgery to remove the excess breast tissue caused by microcalcifications found in the mammography.
Thus, the clinician will report 99318, a common plastic surgery CPT code, as it covers the removal of excess breast tissue due to architectural distortion, calcification, or scarring.
CPT Code 19350 – Nipple-areola Reconstruction
Assume a situation where a breast cancer patient underwent a mastectomy. During the immediate reconstruction surgery, the surgeon also performed nipple-areolar reconstruction. As a result, the surgeon will report reconstructive surgery CPT code 19350.
This code covers the reconstruction of the nipple or areola via several techniques, including C-v flap, skate flap, or nipple sharing. For the unversed, below are the descriptions of reconstruction techniques:
- In nipple sharing, a small portion of the unaffected breast’s nipple is used to reconstruct the affected breast’s nipple.
- In the skate flap, a thin and small skin flap is crafted from the surrounding tissue and shaped into the nipple.
- In the C-v flap, the oval or circular-shaped flap is created and constructed into the nipple.
Reconstructive Surgery CPT Codes for Liposuction
CPT Code 15877 – Suction-assisted Lipectomy
Abdominal fat can be stubborn and lead to severe lower back strain, causing chronic pain and limiting physical activity, such as lifting and bending. Thus, suction-assisted lipectomy (liposuction of the trunk region) can significantly help such patients to remove excess fat.
Surgeons can report plastic surgery CPT code 15877 to bill this procedure. It is performed by inserting a cannula under the skin through small incisions. The fat is broken by moving the cannula back and forth and then suctioned out.
Plastic Surgery CPT Codes for Abdominoplasty
CPT Code 15847 – Excision of Excessive Skin
It is a common plastic surgery CPT code that covers the excision of excessive skin and subcutaneous tissue of the abdomen. Consider a scenario where a patient undergoes significant weight loss either through exercise and diet or via bariatric surgery, which can cause sagging and loose skin hanging over the abdomen. Thus, the abdominoplasty is performed. However, during the procedure, the surgeon discovered a huge amount of unexpected tissue and skin. This complication necessitates the excision of the excessive portion of the tissue.
Reconstructive Surgery CPT Codes for Facelift
CPT Code 15828 – Cheek, Chin, Neck Tightening
This reconstructive surgery CPT code involves the removal of excess fat and skin to tighten the skin of the neck, chin, and cheek. For example, a patient visits the plastic surgeon with deep nasolabial folds, sagging jowls, and loss of skin elasticity in the neck region. Thus, the healthcare practitioners performed the procedure covered under CPT 15828.
This procedure involves making incisions in front of the ears, extending into the hairline and under the chin for tightening and lifting the underlying tissues and removing the excess skin.
CPT Code 15829 – Skin Tightening and Wrinkle Removal
Assume a scenario where a patient encounters the surgeon with evident facial aging signs, such as jowls, smile lines, and sagging skin around the jawline. The patient wants treatment for the same. Thus, the healthcare provider rendered a facelift procedure with common plastic surgery CPT code 15829 involving deep facial tissue dissection and tissue tightening to achieve lift and a more contoured face addressing the jowl issue.
Plastic Surgery CPT Codes for Eyelid
CPT Code 15822 – Blepharoplasty, Upper Eyelid Excess Skin Trimming
It is a plastic and reconstructive surgery CPT code, which requires the physician to surgically trim excess skin from below the upper eyelid. It is typically performed to enhance the cosmetic appearance of the patient.
CPT Code 15823 – Blepharoplasty, Trimming of Excess Skin Due to Vision Issues
This reconstructive surgery CPT code is somewhat similar to 15822 as it also involves the trimming of excess skin from the upper eyelid. However, this code is typically reported where the excess skin interferes with the patient’s vision.
Summary
Let’s quickly recap the most commonly used CPT codes for plastic surgery that we discussed in this guide. We shared descriptors and examples for different types of surgical procedures, including rhinoplasty (30400, 30410, 30420), breast surgery (19350, 19316, 19318), liposuction (15877), abdominoplasty (15847), facelift (15828, 15829), and eyelid surgery (15822, 15823).
The primary aim of this guide was to help you understand the conditions in which you may utilize these procedural codes for rightful reimbursements. However, oftentimes, insurance payers refuse to pay for plastic and reconstructive surgeries, especially when they lack medical necessity. Thus, we recommend establishing open lines of communication with the payers to understand their specific reimbursement guidelines and ensure comprehensive documentation.
