Skip Navigation LinksHome > December 2008 - Volume 61 - Issue 6 > Panniculectomy and Redundant Skin Surgery in Massive Weight...
Annals of Plastic Surgery:
doi: 10.1097/SAP.0b013e3181788e63
Review Article

Panniculectomy and Redundant Skin Surgery in Massive Weight Loss Patients: Current Guidelines and Recommendations for Medical Necessity Determination

Gurunluoglu, Raffi MD, PhD

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Abstract

There is certain insurance coverage criteria for panniculectomy and redundant skin surgery that every plastic surgeon participating in the surgical treatment of massive weight loss patients should be familiar with to accurately document and present the clinical findings of their patients. This article reviews the medical necessity guidelines used by most third-party payers for panniculectomy in massive weight loss patients after bariatric surgery. In addition, insurance coverage criteria for redundant skin surgery and panniculectomy recommended by American Society of Plastic Surgeons (ASPS) for third-party payers were reviewed. Although the criteria used by third-party payers are conceptually similar to those recommended by ASPS, in practice they are harder to meet by most weight loss patients. This discrepancy leads to a group of denied patients who would otherwise be authorized for plastic surgery after massive weight loss, when actual ASPS recommendations are taken into consideration. Furthermore, our search demonstrated that there are no established criteria or guidelines used for different body parts such as inner arms and medial thighs, other than the pannus among third-party payers. This review article points out to the fact that there is a need for development of new set of guidelines for those sites and for modification of current guidelines for medical necessity determination of panniculectomy used among third-party payers, according to actual ASPS recommendations.

© 2008 Lippincott Williams & Wilkins, Inc.

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