Plastic Surgery: Dermatology
Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic (or aesthetic) surgery aims at improving the appearance of it. Both of these techniques are used throughout the world.
Reconstructive surgery is a term with training, clinical, and reimbursement implications. It has historically been referred to as synonymous with plastic surgery.
More accurately, reconstructive surgery should be contrasted with cosmetic surgery. Reconstructive surgery is performed to
1) Improve/restore to normal function.
2) Restore to a normal appearance of "abnormal" or "malformed" body parts caused by the disease or condition and/or
3) Improve the patient's quality of life
Separately, the patient must be healthy enough so that the benefits of the procedure outweigh the risks of complications or death. A procedure could be considered reconstructive but not medically necessary due to the risk to the patient.
In addition Section 1862(a)(1)(A) of the Social Security Act directs the following: "No payment may be made under Part A or Part B for any expenses incurred for items or services not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." Therefore, outside of clinical interpretation and carrier guidelines, there is a federal statute that "improving functionality and restoring appearance" are covered as reconstructive and medically necessary.
This definition is contrasted with cosmetic surgery performed to improve aesthetics or the appearance of a body part. A plastic surgeon can perform both reconstructive and cosmetic procedures. Some procedures, such as a panniculectomy (aka tummy tuck) can be considered as cosmetic by one insurance company and reconstructive by another.
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Journal of Clinical & Experimental Dermatology Research