Popular breast cancer reconstruction procedure could soon be harder to get

By Rachel Polansky

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    ATLANTA (WANF) — A recent change in insurance could soon make it harder for breast cancer survivors to get a common type of reconstruction surgery.

It’s because the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare and works with state governments to provide Medicaid, is considering dropping the specific billing code for DIEP Flap procedures. The treatment involves surgically removing tissue from the lower belly, shaping it and then attaching it to the chest in the form of a new breast.

This potential coding change has already garnered outcry from some breast cancer survivors such as Michelle Scott.

“It feels deceitful and sneaky, like it’s some kind of numbers game,” said Scott, who was diagnosed with breast cancer in 2018 and had a double mastectomy the same year.

After one year of chemotherapy and radiation, Scott had reconstruction surgery in the form of breast implants.

“It worked for a short time,” Scott said. “But eventually, due to the radiation treatments that I had on the left side of my body, my body rejected the implant.”

Scott’s implants were removed, and after multiple hospital stays over two years, she decided to live without two breasts.

“My body was sort of disfigured in a way, so it was difficult to my self-esteem and just my daily existence,” Scott said. That was until earlier this year, when Scott learned about the DIEP Flap reconstruction procedure.

Marietta-based plastic surgeon Dr. Aisha Baron of Breast Body Beauty Plastic and Reconstructive Surgery performs about two of these procedures every month, and said they’re complicated treatments.

“A surgeon has to be skilled in micro surgical technique,” Dr. Baron said. “In addition, it takes a big team in the operating room in order to execute these procedures efficiently and effectively for the patients.”

DIEP flaps are also expensive, roughly $50,000 without insurance.

If Medicare and Medicaid go through with this coding change, plastic surgeons would be paid significantly less for the procedure, which could mean many may stop offering it.

“With these current changes and insurance not wanting to recognize certain codes for these more advanced surgeries, it’s basically a situation where they are almost choosing for patients by decreasing potential access to having these procedures and that’s just not right,” Dr. Baron added.

While federal law requires insurance companies cover reconstructive surgery, it does not specify which type is covered.

Four months ago, Scott opted for the procedure, “and this option for me has made me feel better than I have felt since 2018,” she said. “It has really been lifechanging.”

Now, CMS is reconsidering the coding change; a spokesperson said the American Medical Association and plastic surgeons asked for changes. CMS said it will publish a final decision in August.

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