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Another good example is repair of a cleft palate, or cheiloplasty, which surgically corrects abnormal development, restores function to the lips and mouth and produces a more normal appearance. This meets the definition of reconstructive surgery and is mandated by state laws in at least 31 states,
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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
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Reconstructive surgery represents a small but critical component of the comprehensive care of cancer patients. Its primary role in the treatment of cancer patients is to extend the ability of other surgeons and specialists to more radically treat cancer, offering patients the best opportunity for
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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
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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.
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malformed body member." Therefore, outside clinical interpretation and carrier guidelines, there is a federal statute that "improving functionality and restoring appearance" are covered as reconstructive and medically necessary.
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US Navy 090704-A-0566T-023 Operation Smile staff member Dr. Hal
Rosenfeild begins reconstructive surgery for a cleft lip on a three-month-old infant aboard the Military Sealift Command hospital ship USNS Comfort (T-AH
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Reconstructive surgery procedures include breast implant removal, reduction mammoplasty, breast reconstruction, surgical correction of birth anomalies, congenital nevi surgery, and liposuction for
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Al-Himdani, Sarah; Jessop, Zita M.; Al-Sabah, Ayesha; Combellack, Emman; Ibrahim, Amel; Doak, Shareen H.; Hart, Andrew M.; Archer, Charles W.; Thornton, Catherine A.; Whitaker, Iain S. (2017).
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company and reconstructive by another. The surgeon may not be using the
Medicare or reimbursement criteria when referring to a procedure as reconstructive or cosmetic. Plastic surgeons,
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to manage increasingly complex wounds. This ranges from very simple techniques such as primary closure and dressings to more complex skin grafts, tissue expansion, and free flaps.
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Biomaterials are, in their simplest form, plastic implants used to correct or replace damaged body parts. Biomaterials were not used for reconstructive purposes until after
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Wanchek T, Wehby G. State-Mandated
Coverage of Cleft Lip and Cleft Palate Treatment. Cleft Palate Craniofac J. 2020;57(6):773-777. doi:10.1177/1055665620910529
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Reconstructive surgery is a term with training, clinical, and reimbursement implications. It has historically been referred to as synonymous with
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do reconstructive surgery on faces to correct congenital defects, after trauma and to reconstruct the head and neck after cancer.
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due to the new and improved technology and the tremendous need for the correction of damaged body parts that could replace
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Restore to a normal appearance of "abnormal" or "malformed" body parts caused by the disease or condition and/or
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157:. However, reconstructive surgery is not a specialty and there are no board-certified reconstructive surgeons.
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performed to restore normal appearance and function to body parts malformed by a disease or medical condition.
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and that they can assume the mechanical and functioning roles of the components they are replacing.
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is a recognized medical specialty and a surgeon can be a "board-certified" plastic surgeon by the
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devices has recently been gathered by D. G. Singleton. Papers have covered in depth the U.S.
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757:"Tissue-Engineered Solutions in Plastic and Reconstructive Surgery: Principles and Practice"
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but could be denied as cosmetic by individual insurance companies in the remaining states.
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A successful implantation can best be achieved by a team that understands not only the
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Plastic surgery: a component in the comprehensive care of cancer patients
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687:"Choosing the Right Procedure - American Academy of Cosmetic Surgery"
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More accurately, reconstructive surgery should be contrasted with
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443:"Cosmetic vs Reconstructive Surgery - JF Part A - Noridian"
385:""definition of plastic surgery" - Search Results - PubMed"
713:"Barbed sutures in plastic surgery: a personal experience"
469:"Exclusions from coverage and Medicare as secondary payer"
414:"Certification | Plastic Surgery Clinical Privileges"
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National
Institute of Dental and Craniofacial Research
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Nasal reconstruction using a paramedian forehead flap
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49:. Unsourced material may be challenged and removed.
347:An overview of the standardization and control of
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226:) also perform some reconstructive procedures.
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340:aspects of the problem, but also comprehends
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601:Hasen K.V., Few J.W., Fine N.A., (2002),
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109:Learn how and when to remove this message
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246:. Cosmetic surgery procedures include
174:Improve the patient's quality of life.
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418:American Society of Plastic Surgeons
47:adding citations to reliable sources
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16:Surgery to restore form and function
168:Improve/restore to normal function.
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258:, upper and lower eyelid surgery (
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34:needs additional citations for
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262:), laser skin resurfacing (
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718:Aesthetic Surgery Journal
149:. In regard to training,
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58:"Reconstructive surgery"
189:maxillo-facial surgeons
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530:"Cosmetic Procedures"
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298:Recent literature in
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99:December 2011
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41:Please help
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658:"ANC.00009"
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467:SSA, ORDP.
334:biochemical
276:liposuction
272:rhinoplasty
141:Description
807:Categories
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672:2024-07-12
643:2018-01-04
579:2020-07-08
554:2019-10-28
483:2024-07-02
453:2020-07-08
428:2020-07-08
399:2018-12-17
371:References
349:biomedical
326:anatomical
284:tummy tuck
69:newspapers
252:face lift
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691:Archived
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608:Oncology
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514:12 July
300:medline
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