Plastic Surgery: Medical Necessity Documentation Best Practices

Reconstructive vs. Cosmetic: The Critical Distinction

Proper documentation of medical necessity is essential for reconstructive plastic surgery billing. Understanding the difference between reconstructive and cosmetic procedures is the foundation of compliant billing.

Medical Necessity Criteria

• Functional impairment documentation
• Physical symptoms and limitations
• Failed conservative treatments
• Psychological impact assessment
• Quality of life measurements

Breast Reconstruction Documentation

• Post-mastectomy reconstruction requirements
• Symmetry procedures justification
• Timing and staging documentation
• Implant vs. autologous tissue rationale

Common Documentation Pitfalls

• Insufficient functional impairment details
• Missing pre-operative photographs
• Inadequate conservative treatment history
• Vague medical necessity statements