Reconstructive surgery

Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease, medical condition, or injury. The field of reconstructive surgery includes a wide range of sub-specialties including plastic surgery, craniofacial surgery, oral and maxillofacial surgery, hand surgery, reconstructive microsurgery, and surgical treatment of burns and scars.

Reconstructive surgery is a term with training, clinical, and reimbursement implications. It has historically been referred to as synonymous with plastic surgery. In regard to training, plastic surgery is a recognized medical specialty and a surgeon can be a "board-certified" plastic surgeon by the American Board of Plastic Surgery. However, general reconstructive surgery is not a specialty itself, and there are no board-certified reconstructive surgeons.

More accurately, reconstructive surgery should be contrasted with cosmetic surgery. Reconstructive surgery is performed to

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.

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 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.

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 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, maxillo-facial surgeons and otolaryngologists do reconstructive surgery on faces to correct congenital defects, after trauma and to reconstruct the head and neck after cancer.

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, but could be denied as cosmetic by individual insurance companies in the remaining states.

Other branches of surgery (e.g., general surgery, gynecological surgery, pediatric surgery, plastic surgery, podiatric surgery) also perform some reconstructive procedures.