Abdominal Panniculectomy

Abdominal Panniculectomy A. Medicaid covers abdominal panniculectomy (abdominoplasty, abdominodermatolipectomy) only when there is medical documentation that demonstrates the procedure is: 1. Medically necessary, 2. Reconstructive, 3. Performed to alleviate the patient’s symptomatology, and 4. Performed to improve function. B. Abdominal panniculectomy performed in conjunction with a primary abdominal surgical procedure will be considered as part of the primary surgery. No additional reimbursement will be made toward the abdominal panniculectomy. C. Medicaid recognizes the performance of abdominal panniculectomy as appropriate and medically necessary when performed to relieve clinical signs and symptoms resulting from redundant skin following a massive weight loss, symptomatology related to panniculitis, and/or the facilitation of abdominal surgery for those persons defined as morbidly obese. The surgeon’s documentation must include presenting or past occurrences of any of the following signs and symptoms including, but not limited to: 1. Pain to abdominal pannus and/or lower back, 2. Impaired ambulation, 3. Interference with personal hygiene, 4. Signs and symptoms of panniculitis, 5. Large redundant fold of skin and fat hanging below the groin, 6. Recurrent intertrigo to the overhanging pannus resulting in skin infections, 7. Body Mass Index greater than thirty (30), 8. Presence of lymphedema, abscesses or hernias, and 9. Documentation of size and configuration of pannus as evidenced in photographs. D. Prior approval for abdominal panniculectomy is not required. 1. The surgeon must retain all documentation supporting medical necessity in the medical record. 2. The final determination of medical necessity will be made by the surgeon based on the criteria listed in this Rule.