Overlap Between Gender Reassignment Surgery and Cancer

From Health Care Blog

By Shira Stein | July 23, 2018

It’s not intuitive, but there’s a big overlap between gender reassignment surgery and cancer surgery. Not in the doctors who work with these two sets of patients, but in the way that the doctors bill insurance companies for their care.

While reporting a story about Medicare’s coverage of gender reassignment surgery, I wanted to look at how many times providers had billed for procedures related to gender reassignment surgery. Another reporter and I looked at the numbers the Centers for Medicare & Medicaid Services released, but the results ended up showing these codes were used a lot prior to 2014, when CMS started covering gender reassignment surgery.

I finally asked one doctor who specializes in genital reconstruction and he told me that many of the codes overlap with codes used for cancer surgery. Because it’s so new for insurance to cover gender reassignment surgery, doctors started using codes that make sense, and they happened to be codes that were created for cancer procedures.

That led the other reporter and me to look at only eight service codes of the total 46 that can be used for gender reassignment surgery. The doctor told me that those eight codes were primarily used for male to female genital reconstruction, although they still had some use for other procedures.

Although this meant that we couldn’t get at the information we really wanted, it did help us to compare the cost of top surgery for transgender patients and the cost of a mastectomy for cancer patients.

Reporting doesn’t always go where you want it to, but it ends up resulting in new angles that you don’t expect.

Read my article on our enhanced news site.

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