Thread by @EithanHaim

In May 2022, surgeons who perform "gender reassignment" surgery were instructed to bill insurance for breast reductions, not mastectomies.

This makes no sense though - these are two very different surgeries.

What was the reason for this drastic shift?

AMA guidance 🧵

Some background first.

Whenever a doctor treats a patient they have to submit a code for WHAT they did (treatment) and WHY they did it (diagnosis).

This is how doctors get reimbursed.

The CPT system is used to code treatments; ICD codes used for diagnosis.

CPT (Current Procedural Terminology) codes can be seen as the language doctors use to communicate with insurance.

AMA has a copyright on this "language" which earns them hundreds of millions a year in royalties/licensing fees.

Nearly $500 million a year to be exact.

To put this in perspective, consider that…

AMA ranks #7 in spending among ALL lobbying organizations.

AMA annual revenue is greater than next four professional medical orgs combined.

Largest medical organizations with most members (about 290,000).

In clip below, AMA President, explains their role in transgender medicine:

Specialty organizations (i.e. WPATH, AAP, ES) "bring the science" then AMA "creates the policy."

But what exactly is that policy? And how does that allow mastectomies to be billed as reductions?

A policy is proposed by AMA members and then voted on at AMA House of Delegates.

They can also come from AMA Board of Trustees - like in Report 23 which seeks to "identify issues with physician payment and reimbursement for gender affirming care."

But how does AMA affect "physician payment and reimbursement?"

CPT coding!

Since the AMA owns the CPT codes, the Board of Trustees hand picks those on the editorial panel who revise the codes every year.

These changes can alter which codes (i.e. treatments) are deemed medically necessary for a given diagnosis.

In May 2022, multiple insurance policies cited "AMA guidance" for the claim that breast reduction was medically necessary for "gender affirming chest surgery."

Blue Cross Blue Shield-Illinois updated their policy.

CPT code for mastectomy would no longer be used; instead they would use CPT code for breast reduction.

One major problem - these are completely different surgeries!

One REDUCES breast tissue (breast function preserved), the other REMOVES the entirety of breast tissue (breast function lost).

I'm no legal expert but it would seem this type of scheme to code for one procedure while doing another would be well within the territory of criminal violation of the False Claims Act.

But consider all the ways this could solve the "issues with physician payment and reimbursement for gender affirming care." (BoT Policy 23)

-Broader range of diagnoses (ICD codes) can be used for breast reduction as opposed to mastectomy - latter typically requires a biopsy-proven cancer diagnosis.

-Expands pool of providers. General surgeons traditionally perform mastectomies since we are trained to manage the manage the cancer side. But plastic surgeons are just as capable when it comes to non-cancer cases. Also, breast reduction is a traditional plastics procedure so no red flags would be raised when CPT code for reduction gets billed to insurance.

-Plastic surgery more traditionally affiliated with "sex reassignments" surgeries. Also more likely to work in private clinics which tend to exist further outside the purview of federal and state oversight.

-Mitigates negative public opinion. Public billing data would show healthy young women undergoing breast reductions (not horrifying) instead of bilateral mastectomies (horrifying).

Yet AMA's policies go much farther than just "reducing barriers."

One policy (see images) seems to support coordinated assistance for doctors who violate Red State bans on abortion/pediatric gender interventions.

This policy creeps dangerously close to advocating for outright violation of these laws.

I understand all of this seems farfetched.

But consider that three doctors have already been sued by Texas AG for allegedly using false billing codes to circumvent State's ban on pediatric gender interventions.

Also, mainstream publications (link below) openly print stories about this - a transgender man wanted a hysterectomy but his insurance didn’t cover gender-affirming care, Gorton would enter the ICD-10 code for pelvic pain, as opposed to gender dysphoria, into the patient’s billing record.

Activist organizations even publish tool kits outlining these false billing codes, specifically including breast reduction.

During a House hearing, I discussed one of these tool kits from the Campaign for Southern Equality with Rep Brandon Gill. Immediately after, the tool kit was scrubbed from the internet (see images).

kffhealthnews.org/news/article/m…

Final thoughts...

The AMA serves a critical function as one of the terminal endpoints of the transgender laundering scheme.

1) Activist organizations like WPATH and AAP produce the fraudulent research which is then presented to AMA as "the science" (remember video from before).

2) AMA adopts policies stating these interventions are "evidenced based" and "medically necessary" (see image).

3) AMA legitimizes the field indirectly through the false consensus and then directly through CPT coding, both of which serve the end goal of ensuring coverage from insurance companies and Medicare/Medicaid.

I included a few sources, including a recent story involving the President of the AMA.

city-journal.org/article/americ…

x.com/benshapiro/sta…

x.com/benshapiro/sta…

thebignewsletter.com/p/how-the-amer…