General Surgery Medical Billing Services

More than most surgeons expect. When claims are built from the booked procedure, any additional work performed in theatre goes unbilled even though the report describes it clearly. Reviewing one month of operative notes against submitted claims almost always finds uncaptured procedures. It requires no change to how you operate, only to how coding is sourced.

Make the window visible at the front desk. Log every procedure date with its global length so scheduling and check-in staff see a flag when a patient returns inside it. Routine follow-up is already paid for, and billing it separately gets reversed months later. Prevention costs almost nothing, while appealing a recoupment rarely succeeds.

When the care is genuinely unrelated to the original procedure, or represents a staged or unplanned return to theatre. Each situation has its own modifier, and the note must explain why the visit was separate. Surgeons often provide this care and never bill it because nobody flagged it at the time. Capturing it at the visit is what makes it recoverable.

Yes, when the operative report documents their specific role and why assistance was necessary. That claim is frequently never filed at all, particularly when the assistant belongs to a different practice. The report has to name them and describe their participation rather than simply listing them as present. We review reports for assistant involvement as part of standard coding.

Payer editors apply automatic reductions to secondary procedures, and the percentage does not always match your agreement. The difference lands in the contractual adjustment bucket and disappears if payments post in bulk. Line-level posting against loaded contract rates exposes it. We appeal every variance above threshold, which typically recovers meaningful revenue in the first quarter.

Considerably. Open, laparoscopic, and robotic approaches often map to different codes with different values, and some payers apply specific policies to robotic cases. A report that does not clearly state the approach forces a conservative code choice. Stating it explicitly in every operative note protects the claim and removes a routine source of downcoding.

Before the case is confirmed with the patient. Approvals carry expiry dates, and a procedure moved to a later date can fall outside the approved window. Operating first and seeking approval afterwards almost never works. We record approval numbers with expiry dates and re-verify whenever a case is rescheduled, which is where most authorisation failures actually occur.

The operative report itself, paired with the specific policy language the payer applied. Appeals that quote the payer's own criteria and point to the paragraph of the report satisfying it succeed far more often than general letters. That is why complete operative documentation matters beyond the original claim. It is the evidence every later dispute depends on.

Usually a worthwhile portion. Aged surgical balances often sit unresolved because reconstructing a case takes effort a departing vendor has no reason to spend. We triage by dollar value and remaining appeal window, work the largest recoverable claims first, and report what we find. The patterns typically reveal what to correct in the current workflow too.

Collections and denials broken out by surgeon and by facility, not just a practice total. Blended figures hide the fact that one surgeon's documentation or one facility's data handover is driving the problem. You should also see average procedures billed per case. When that number is low, it usually confirms claims are being built from schedules rather than reports.