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2008 Annual Meeting Abstracts

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Examination of Factors Impacting Reimbursement for Abdominoplasty
Michele A. Shermak, M.D., Shelly Choo, B.S., Jessie Mallalieu, P.A.-C, Catherine Oldencamp, B.A., David Chang, Ph.D., MPH, MBA.
Johns Hopkins Hospital, Baltimore, MD, USA.

PURPOSE: Increasing demand for abdominoplasty parallels both the growth of the massive weight loss (mwl) population and the increasing appetite the public has for cosmetic enhancement surgery. The recent CPT coding update for abdominoplasty underlines not only the variability of the population seeking the procedure but also the interest in capturing fair reimbursement for surgeons. With the notable growth in numbers of abdominoplasty procedures performed, we studied our experience with reimbursement and factors that impacted reimbursement, and indirectly, access to care.
METHODS: From July 2004 to June 2007, 245 patients were billed for CPT code 15831 or 15830. Variables including age, gender, race, BMI, time to surgery, associated surgical procedures, and weight of abdominal tissue removed at surgery were noted. Additionally, financial variables including mode of payment, billing dates, and compensation were recorded. Twenty different insurance plans were noted and categorized as a single “commercial insurance” group in our analysis, with the other two study groups categorized as “self pay” or “Medicare” patients. Statistical analysis was performed in Stata SE, version 9.
RESULTS: Of the 245 patients studied, 219 were female and 26 were male. Average age was 43 years, and average BMI was 32.3. Average time to surgery from consultation was 136 days. Average weight of abdominal tissue removed was 2.9 kg. Eighty-seven patients paid for cosmetic surgery (“self pay”), while 134 utilized commercial insurance plans and 24 had Medicare coverage. One hundred sixty patients (65%) had a history of gastric bypass surgery (gbs) and mwl. One hundred fifty (61%) had procedures performed in conjunction with their abdominoplasty, including hernia repair, bodylifts, and breast surgery. We found Medicare paid 28% less than commercial insurance, and that commercial insurance paid 48% less than patients who prepaid for cosmetic abdominoplasty surgery. Of the 24 Medicare patients, 16 (67%) resulted in zero payment for services rendered. On multiple logistic regression analysis, factors found to significantly impact payment for service were BMI, history of gbs, and coincident hernia repair. BMI negatively impacted reimbursement, with every unit increase in BMI leading to a 0.77 percentage point reduction in reimbursement, controlling for mode of payment, i.e. a BMI difference of 10 decreased payment by almost 8%. (p=0.04) Coincident hernia repair was associated with 17.5 percentage points reduction in reimbursement. (p=0.002) In contrast, history of gbs improved reimbursement for abdominoplasty by a factor of 11. (p=0.01) Neither age, gender, race, nor weight of tissue removed significantly impacted reimbursement.
CONCLUSION: We found that a greater degree of obesity and coincident hernia repair impaired reimbursement for abdominoplasty, while mwl after gbs improved compensation. While having patients pay for their surgery guarantees the best reimbursement, strategies such as assuring authorization prior to surgery, which Medicare will not do, will secure better reimbursement.


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