Plastic Surgery Medical Billing Services

Visual evidence more than narrative. Photographs, measurements, and a documented history of failed conservative treatment carry the most weight with reviewers deciding whether a procedure is functional or cosmetic. Requests with only a clinical description are frequently denied. We build a standard evidence packet for each procedure type so nothing is missing when the request goes out.

State the impairment plainly and specifically. Describe what the patient cannot do, the symptoms involved, and what conservative treatment failed to resolve. Vague language about improvement invites a cosmetic determination. The surgeon's own words matter here, because reviewers look for a functional problem being corrected rather than an appearance being enhanced.

At booking, under a written estimate, never on the day of surgery. Cosmetic work is a cash business, and chasing payment afterwards has poor recovery rates once the procedure is complete. A deposit at scheduling with the balance due before the theatre date is standard practice. We support the estimate and the paperwork so your coordinator can be consistent.

By splitting the charges and telling the patient in advance. The covered portion goes to insurance with its own documentation, and the cosmetic portion is quoted and collected separately. Blending them causes the insurer to deny and the patient to dispute. A written breakdown before surgery prevents both, and it protects your relationship with the patient.

Federal law requires many plans covering mastectomy to also cover reconstruction, including procedures on the other breast for symmetry and treatment of resulting complications. Patients are frequently unaware. Confirming what applies at the consultation both serves the patient and prevents your practice from treating covered work as cosmetic. We check this during initial verification.

Usually global period billing. Routine post-operative visits are included in the surgical fee, and charging them separately gets paid initially then reversed on later review. Complications and unrelated care remain billable with the right modifier. We log every procedure date with its global length so returns are flagged at check-in rather than caught afterwards.

Consistently, and with the patient's consent recorded. Standardised views and lighting make the functional problem visible to a reviewer who has never met the patient. Inconsistent images weaken otherwise strong requests. Store them securely as protected health information. We specify which views each procedure type needs so your staff can capture them the first time.

Yes, and the distinction is exactly the kind insurers scrutinise. One may be covered when documented functional problems such as recurrent skin breakdown are present and conservative treatment failed. The other is generally cosmetic. The operative note and the pre-operative documentation must clearly support which procedure was performed and why.

Yes, and they need different handling. Insurance work runs through verification, authorisation, and claim submission. Cosmetic work needs estimates, deposits, and payment tracking rather than claims. We manage both and report them separately, so you can see how each part of the practice is genuinely performing instead of looking at a blended figure.

Standardising the reconstructive evidence packet. Most denials on covered procedures come from incomplete submissions rather than genuinely uncovered work. Define exactly which photographs, measurements, and treatment history each procedure type needs, then submit that same packet every time. Approval rates rise noticeably within the first quarter, and nothing about your clinical practice has to change.