Fijany Arman J, Friedlich Nicole, Olsson Sofia E, Bishay Anthony E, Pekarev Maxim
Surgery, Vanderbilt University Medical Center, Nashville, USA.
Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA.
Cureus. 2023 Aug 21;15(8):e43855. doi: 10.7759/cureus.43855. eCollection 2023 Aug.
Introduction In 2019, the Centers for Medicare & Medicaid Services (CMS) combined all autologous breast flap procedures under one billing code, effective from December 31, 2024. This change will result in equal insurance reimbursement rates for popular flap options, such as transverse rectus abdominis muscle (TRAM) and deep inferior epigastric perforator (DIEP) flaps, which were previously billed separately using S-codes based on complexity. Methods This study aimed to analyze insurance code changes for autologous breast reconstruction flap procedures. Data were collected from the American Society of Plastic Surgeons' annual plastic surgery statistics reports, including specific insurance codes and case volumes from 2007 to 2020. A comprehensive analysis was conducted to assess recent trends in flap utilization rates, documenting any modifications or additions to the existing codes and their implementation years. Results The study analyzed billing codes and case volumes for autologous breast reconstruction procedures, with a focus on the DIEP flap and other alternatives. Non-autologous breast reconstruction procedures showed consistently higher case volumes compared to autologous procedures from 2007 to 2020. Notably, the popularity of the DIEP flap surpassed that of other flap options after 2011. Conclusion The removal of S-codes for autologous breast reconstruction by CMS and the subsequent potential decrease in insurance coverage for the DIEP flap may lead to a decrease in its utilization and a shift toward more invasive options, like the TRAM flap. This change could result in financial burdens for patients and widen socioeconomic disparities in breast reconstruction, limiting access to preferred reconstructive methods and impacting patient autonomy and overall well-being.
引言 2019年，医疗保险和医疗补助服务中心（CMS）将所有自体乳房皮瓣手术合并为一个计费代码，自2024年12月31日起生效。这一变化将导致常见皮瓣选择（如腹直肌横肌（TRAM）和腹壁下深动脉穿支（DIEP）皮瓣）的保险报销率相等，此前这些皮瓣根据复杂程度使用S代码分别计费。方法 本研究旨在分析自体乳房重建皮瓣手术的保险代码变化。数据收集自美国整形外科医师协会的年度整形手术统计报告，包括2007年至2020年的特定保险代码和病例数量。进行了全面分析，以评估皮瓣使用率的近期趋势，记录现有代码的任何修改或增加及其实施年份。结果 该研究分析了自体乳房重建手术的计费代码和病例数量，重点是DIEP皮瓣和其他替代方案。2007年至2020年，非自体乳房重建手术的病例数量始终高于自体手术。值得注意的是，2011年后DIEP皮瓣的受欢迎程度超过了其他皮瓣选择。结论 CMS取消自体乳房重建的S代码以及随后DIEP皮瓣保险覆盖范围的潜在减少可能导致其使用率下降，并转向更具侵入性的选择，如TRAM皮瓣。这一变化可能给患者带来经济负担，并扩大乳房重建中的社会经济差距，限制获得首选重建方法的机会，影响患者的自主权和整体幸福感。
