Panniculectomy
Cosmetic surgery, or expenses incurred in connection with such surgery, are not covered by Medicare. Cosmetic surgery includes any surgical procedure directed at improving appearance, except when required for the prompt (i.e., as soon as medically feasible) repair of accidental injury or for the improvement of the functioning of a malformed body member.
Panniculectomy
Abdominal lipectomy/panniculectomy is surgical removal of excessive fat and skin from the abdomen. When surgery is performed to alleviate such complicating factors as inability to walk normally, chronic pain, ulceration created by the abdominal skin fold, or intertrigo dermatitis, such surgery is considered reconstructive. Preoperative photographs may be required to support justification and should be supplied upon request.
Meets Medical Necessity
- The panniculus hangs below the level of the pubis
- The panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing)
- Intertrigo consistently recurs over three months while receiving appropriate medical therapy, or remains refractory to appropriate medical therapy over a period of three months
Does Not Meet Medical Necessity
- Treatment of neck or back pain
- Improving appearance (i.e., cosmesis)
- Repairing abdominal wall laxity or diastasis recti
- Treating psychological symptomatology or psychosocial complaints
- When performed in conjunction with abdominal or gynecological procedures (e.g., abdominal hernia repair, hysterectomy, obesity surgery) unless criteria for panniculectomy and abdominoplasty are met separately
References
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Panniculectomy Documentation Checklist
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Yes
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No
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N/A
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Section A — Patient Complaints and Physical Signs
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The panniculus hangs below the level of the pubis
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The panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing)
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Intertrigo consistently recurs over three months while receiving appropriate medical therapy, or remains refractory to appropriate medical therapy over a period of three months
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There is a presence of a significant functional deficit that prohibits or profoundly impairs the ability to perform activities of daily living due to a significant physical deformity or disfigurement resulting from the excess skin folds, and surgery is expected to restore or greatly improve the functional deficit
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For Panniculectomy
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A brief description of the panniculus, underlying skin, and conservative treatment undertaken and its results
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Reconstructive Surgery
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Documented physical findings of the anatomic defect
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Section B — Photographs
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For Panniculectomy
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Photographs of ulcerative abdominal folds, intertrigo dermatitis
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For Reconstructive Surgery
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Photographic documentation clearly demonstrating the anatomic defect
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Preoperative exam and notes
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Postoperative notes
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