"The problem is that there are many patients requesting blepharoplasty for cosmetic indications, who are looking for insurance coverage to avoid having to pay for it." - Dr. Wheatley
Portland, OR (PRWEB) November 12, 2012
Blepharoplasty involves the surgical removal of excess skin and fatty tissue around the eyes. The three most common indications that patients present when seeking blepharoplasty, said Dr. Wheatley, are dry eyes, difficulty seeing and excessive tearing. Even a small degree of superior visual field obstruction, he noted, can affect activities of daily living.
According to Dr. Wheatley, a board-certified plastic surgeon, "Patients with visual field obstruction resulting from eyelid drooping or other conditions can significantly benefit from blepharoplasty." Current blepharoplasty guidelines developed by several professional societies and organizations have varying requirements for specific visual field testing and/or photographic findings.
Regardless of the specific requirements of various health plans for covering blepharoplasty, determining medical necessity must be supported with thorough clinical documentation including:
- Medical History
- Physical Exam
- Visual Field Testing
Together, these components of the patient workup should fit together to form a cohesive whole picture. "If any one of these components is an outlier or if findings are inconsistent, then that would suggest that the procedure is cosmetic," said Dr. Wheatley. "Some patients may manipulate visual field test findings, so it is critical for photographic findings to be consistent with test results." Independent medical review is valuable in determining medical necessity since blepharoplasty cases can vary subtly. "Using a board-certified physician who looks at a lot of these cases and performs the actual procedures can really be helpful to evaluate the visual field studies and the quality of photographs."
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