General Surgery Billing and Coding Services
Global surgical packages, modifiers 22, 58, 78 and 79, assistant surgeon claims and call coverage.
General surgery revenue lives and dies on the global package. Every post-operative visit inside the global is already paid for. Every return to theatre is a modifier decision. Unusual difficulty is only paid if the operative note documents it, and the claim asks for it. Our general surgery billing and coding services read the note before choosing the modifier.
Groups comparing general surgery billing services should also ask about emergency call. Unassigned patients, assistant surgeon claims and out-of-network emergency care each have their own rules. The surprise billing regulations mean your network status at each facility has to be known, not assumed.
Our Services
No Two Operations Are the Same
Every operation can throw up something new. If a case surprises you, it surprises us too. But a surgical billing service that is not ready for the unusual is not much use, so we stay current, stay flexible and think each one through.
Our team is good, and our decade in this industry is what makes them good. In that time we have learned the detail of general surgery billing services, which is what makes us a partner worth having.
What benefits are provided by our Surgical Billing Services and Surgical Coding Services?
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Subject Matter Experts
We handle both routine and complex surgery. The coding, the billing and the collection are all done by people who know the work, which keeps your practice moving instead of waiting on claims.
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Regulation Compliance
Claim rules differ from state to state, and we know those differences. It is not just something we can talk about. It shows in how we build and file the claim, and in how often that claim gets paid.
Procedure
Our pediatric billing covers every specialty, supported by the expertise of a specialized coder and, indispensably, a skilled biller:
- Mastectomy
- Lower Back Pain Surgery
- Partial Colectomy
- Inguinal Hernia Repair
- Prostatectomy
- Hysteroscopy
- Tonsillectomy
- Hysterectomy
- Skin Grafting
- Hemorrhoidectomy
- Coronary Artery Bypass
- Dilation and Curettage
- Dilation and Curettage
- Debridement of Wound, Burn, or Infection
- Appendectomy
- Carotid Endarterectomy
The global period decides most surgical claims
Surgical billing is mostly a question of what is already included in the payment and what is not. Get that boundary wrong in either direction and it costs you.
Ten days or ninety
Minor procedures carry a ten day global period. Major surgery carries ninety, and the ninety day one starts the day before the operation. Inside the window, routine after care for that problem is already paid for. Billing it again invites a review.
The opposite mistake is more expensive and far more common. Practices write off everything that happens in the window, including work that is separately payable, because it is easier than deciding. That is revenue given away every week.
The modifiers that reopen the window
- Staged or relatedA planned second stage, or a related procedure during the global period, billed with the staged procedure modifier.
- Unplanned return to theatreA complication that takes the patient back to the operating room. Payable, at a reduced rate, with its own modifier.
- UnrelatedA completely different problem during someone else's global period. Payable in full when the diagnosis supports it.
- Unrelated visitAn office visit during a global period for a different problem, which needs its own modifier and its own diagnosis.
Each of these is a different modifier and payers do not treat them as interchangeable.
More than one surgeon
An assistant surgeon, a co-surgeon and a surgical team are three different billing arrangements with different modifiers and different payment. The operative report has to support whichever was billed, by name, with what that person actually did. A report that lists an assistant without describing their role is the version that gets denied.
Multiple procedures in one session
When several procedures are done in the same session, the additional ones are paid at a reduced rate. That is expected. What goes wrong is the order: the highest valued procedure has to be first on the claim, or the reduction is applied to the wrong one and the claim underpays quietly.
Unlisted codes need a report and a comparison code, and they will not pay without both.
General Surgery Credentialing, Privileges and Call Coverage
General surgery credentialing is standard physician enrollment. But the thing that decides your schedule is hospital privileges. Each facility runs its own medical staff process, with its own committee calendar and its own list of privileges by procedure. A surgeon contracted with every payer in town still cannot operate until each facility finishes. Privileging routinely takes longer than payer credentialing, so start it first.
Call coverage is the second piece. Emergency department call agreements are negotiated with the hospital, separately from privileges. They bring their own billing questions: unassigned patients, out-of-network emergency care, and the surprise billing rules that now cover it. Those rules make it important to know and document your network status at each facility, rather than assume it.
We coordinate payer enrollment and facility privileging. See our medical credentialing services.