Obesity is one of the most common health problems in the United States. More than 42.5% of adults in the country are obese, and 9% are suffering from severe obesity. While a lot of people try to get in shape via exercise and diet control, many people opt for cosmetic surgeries and procedures.
One such procedure is suction-assisted lipectomy. However, medical billing for these procedures is confusing, and many healthcare providers make mistakes. In this blog, we will focus on explaining CPT code 15877, which is used to report liposuction.
Our explanation includes a detailed description of the code, how it is used in the real world, its applicable modifiers, and some billing guidelines. So, let’s start.
CPT Code 15877 Description
CPT code 15877 is a medical billing code used to identify the suction-assisted lipectomy of the trunk. Suction-assisted lipectomy, or liposuction, is a medical procedure that is performed to remove excess subcutaneous fat from trunk areas like the abdomen, back, and flanks using a suction technique.
Liposuction falls under the category of plastic surgery and is one of the most sought-after procedures today. Mostly, suction lipectomy is done for cosmetic goals. However, in some cases, it can also be used for medical purposes. For example, suction lipectomy can be used to treat conditions like Lipedema, which is an abnormal buildup of fat that causes continuous pain and discomfort to patients.
This justifies its use beyond aesthetics. However, to bill the procedure correctly, you need to know when and how you can apply the CPT code 15877.
Appropriate Use Cases for CPT Code 15877
To better understand the use of CPT code 15877, let’s look at some scenarios where it can be used.
Persistent Abdominal Fat
Imagine a 35-year-old woman who is trying to lose weight, but even after going to the gym and eating clean for years, the lower belly fat is not reducing. Maintaining her shape is important for her. She consults a plastic surgeon, who recommends she get a suction lipectomy.
The procedure will remove the localized fat deposits, giving her the flatter abdomen that she has been targeting. After the procedure, the physician bills the insurance payer with CPT code 15877.
Lymphedema Management
In our second example, let’s consider a 55-year-old patient who has chronic lymphedema, which was caused by surgery for breast cancer. The swelling from the condition has caused her to gain a lot of extra fat around her trunk area. This causes discomfort and difficulty in moving. This situation also puts her at risk for infections.
To help her, the physician decided to perform a suction lipectomy (CPT code 15877), which removed the extra fat.
Modifiers to Append with CPT Code 15877
Appending the correct modifiers to CPT code 15877 is essential for accurate billing. The following modifiers can be used with 15877:
| Modifier | Description | Application to 15877 |
|---|---|---|
| 22 | Increased Procedural Services | Complex procedure requiring extra effort |
| 51 | Multiple Procedures | Secondary procedure in a multi-procedure session |
| 52 | Reduced Services | The procedure is partially reduced or discontinued |
| 59 | Distinct Procedural Service | Multiple areas within the trunk, separate procedures |
| 80 | Assistant Surgeon | The assistant surgeon aids the primary surgeon |
| 81 | Minimum Assistant Surgeon | Another surgeon provides minimal assistance |
| GY | Item or Service Statutorily Excluded | Non-covered service, e.g., cosmetic procedure |
Reimbursement Guidelines for CPT Code 15877
While billing for suction lipectomy covered by CPT 15877, you must pay attention to the following factors to guarantee fair and timely payment collection.
Reimbursement
The reimbursement for CPT code 15877 varies from payer to payer. Medicare’s stance is clear: cosmetic procedures do not qualify, but exceptions exist for rare medical needs. Some private insurance companies cover 15877 with proof of necessity, while others don’t. However, in most cases, patients are responsible for paying the entire amount.
Medical Necessity
Insurers who pay for CPT code 15877 require proof that the liposuction was not cosmetic. To prove this, submit patient histories, photos, and physician notes showing how the procedure addressed a health issue.
Documentation
Comprehensive documentation is also essential to prove the medical necessity. It should include the treated areas (e.g., abdomen, flanks), the fat volume removed (e.g., 500 cc), the technique (suction-assisted), and any complications.
Insurance Verification
Check coverage upfront. As we stated before, most plans exclude cosmetic liposuction, but some cover medical cases with prior approval. So, check the patient’s insurance details before providing any services, as it will prevent claim denials.
Final Thoughts on CPT Code 15877
CPT code 15877 is an essential medical billing code used for suction-assisted lipectomy of the trunk area. It is usually used for cosmetic purposes. However, it can sometimes be used for medical needs, such as lymphedema management. Since it is more geared toward cosmetic purposes, Medicare does not provide reimbursement for code 15877.
If you are getting continuous claim denials or have complex billing cases, contact our experts for the best plastic surgery billing services. Our expertise ensures compliance and improved revenue collection.
