Plastic surgery runs a dual book: covered reconstruction and cash-pay cosmetic. The line between them is documentation. We code reconstruction for medical necessity approval and manage cash-pay cosmetic as its own revenue stream.
We see the same patterns across plastic surgery groups. The leaks are specific, recurring, and fixable with coding discipline and payer-aware claim construction.
Not a complete list. A representative slice of the codes that drive revenue and denials for plastic surgery practices.
| Code | Description | Profile |
|---|---|---|
| 15100 | Split-thickness skin graft, first 100 sq cm | High volume |
| 15734 | Myocutaneous flap, trunk | Modifier-sensitive |
| 19340 | Immediate breast reconstruction | Denial-prone |
| 19357 | Breast reconstruction with tissue expander | High volume |
| 15877 | Suction lipectomy, trunk | Modifier-sensitive |
| 17999 | Unlisted procedure, skin (cosmetic) | Denial-prone |
Reconstructive documentation built around medical necessity (functional impairment, congenital anomaly, post-surgical, post-trauma). Cosmetic workflow separated into cash-pay with pre-payment. Photo documentation coordinated for reconstruction auth.
Pattern we see. Reconstruction denied as cosmetic without functional impairment documentation, panniculectomy (15830, 15847) denied without BMI and hygiene complication history, and breast reduction (19318) denied without conservative therapy documentation.
How we fix it. Every denial is logged against its CARC/RARC code and routed to a coder who owns the appeal. We rebuild the claim with the documentation the payer is actually asking for, not a generic reconsideration letter. Recovery rate on appealable plastic surgery denials averages above 60 percent.
A written 30-day diagnostic. Dollar figures against every finding. No obligation.