Question 1

What is a global period in general surgery billing?

Accepted Answer

A global period is the span around a procedure during which the surgeon's payment covers routine care. Most major abdominal operations carry 90 days, and many minor procedures carry 0 or 10 days. Postoperative visits inside the window are not billed separately unless they are unrelated and reported with a modifier such as 24. We log included visits with 99024 so none are billed by mistake.

Question 2

How do you code hernia repairs?

Accepted Answer

Ventral, umbilical, epigastric, incisional and Spigelian hernia repairs use one code family, 49591 to 49596 for a first repair and 49613 to 49618 for a recurrence, whatever the approach. The code comes from the total size of the defect and from whether the hernia is reducible or incarcerated, and mesh is included. Inguinal and femoral repairs use their own codes, including laparoscopic and recurrent repairs. We take the measurement from the operative note, so the note needs to record it.

Question 3

How is the hernia defect size measured for coding?

Accepted Answer

The total defect size is the largest distance, craniocaudal or transverse, between the outer margins of the fascial defect, not the size of the sac. It should be measured before the defect is opened, because the fascia retracts and makes the gap look larger, or taken from a CT scan. Several defects close together are measured as one from the top of the highest to the bottom of the lowest, and defects separated by 10 cm or more of intact fascia are measured separately and added. The operative note needs to state the number.

Question 4

What is the global period for a hernia repair?

Accepted Answer

The 2023 anterior abdominal hernia codes, 49591 to 49622, carry a 0 day global period, so the follow up visits after a ventral or umbilical repair can be billed. Inguinal and femoral repairs still carry a 90 day global period. Mixing the two up either loses visit revenue or bills visits that are included, so we set the period for each code and each payer.

Question 5

Can two hernia repairs be billed in one operation?

Accepted Answer

Yes, when they are at different anatomic sites and each is medically necessary, such as an inguinal and a ventral hernia. Report both codes. If an NCCI edit pairs them, a distinct site modifier such as 59 or XS goes on the second code, with notes that support separate sites, and the multiple procedure reduction applies to the second repair. A hernia repaired at the incision site of another abdominal operation is not billed separately under NCCI.

Question 6

How is component separation billed with a hernia repair?

Accepted Answer

Component separation, code 15734, is reported once for each side that is released, and a bilateral release is two lines with a modifier such as 59 or XS on the second. 15734 is an open procedure code, so a complex laparoscopic release is reported with the unlisted code 49659. Mesh is never added as its own line, and debridement of the wound is included unless a separate wound was treated.

Question 7

What happens when a laparoscopic case is converted to open?

Accepted Answer

The completed procedure is what gets reported, so a converted case is billed with the open code and not with both. If the conversion or adhesions made the work substantially greater, modifier 22 can be added, and most payers want the operative note and a short explanation with the claim. We prepare both.

Question 8

When do you bill modifier 22?

Accepted Answer

Modifier 22 is for work that is substantially greater than usual for the code, such as extensive adhesions, a very difficult dissection or a significantly longer operation. It is not for routine difficulty. The operative note has to describe what made the case harder, and payers often expect the extra time and effort to be stated.

Question 9

When do I use modifier 25 versus modifier 57 on a surgeon's E/M visit?

Accepted Answer

Use modifier 57 when an E/M visit on the day of or the day before a major procedure with a 90 day global period results in the decision to operate. Use modifier 25 for a significant, separately identifiable E/M on the same day as a minor procedure with a 0 or 10 day global, because Medicare includes the decision to do a minor procedure in the procedure payment. For the 0 day hernia codes, payers differ, so we check the plan policy.

Question 10

Is Medicare cutting payment for modifier 25 visits in 2027?

Accepted Answer

It is proposed, not final. The CY 2027 physician fee schedule proposed rule, published in July 2026, would pay the most expensive service at 100 percent and the other service at 50 percent when an office or outpatient E/M with modifier 25 is billed with a 0, 10 or 90 day global procedure by the same physician on the same day. Comments closed September 14, 2026. We are watching the final rule before changing any billing.

Question 11

How do you bill robotic-assisted general surgery cases?

Accepted Answer

Report the CPT code that describes the procedure performed, not a separate robotic line. HCPCS S2900 describes use of the robotic system, but Medicare does not pay S codes, and UnitedHealthcare's commercial policy treats it as integral and not separately reimbursed. That policy also says modifier 22 is not appropriate when used only to report robotic assistance. Other payers differ, so our coders check each plan's robotic policy.

Question 12

How is a laparoscopic cholecystectomy with an intraoperative cholangiogram coded?

Accepted Answer

Choose one code from the stepped set. 47562 is laparoscopic cholecystectomy, 47563 adds cholangiography, and 47564 adds exploration of the common duct, and they are not reported together. Cholangiography is often described deep in the operative report and missing from the summary, so our coders read the whole note. Whether a surgeon can also report the radiology supervision and interpretation code 74300 varies by payer, so check the policy first.

Question 13

Can I bill a biopsy and an excision of the same lesion on the same day?

Accepted Answer

Usually not. Under the NCCI policy manual, a biopsy is reported separately only when the pathology result leads to an immediate decision to proceed with a more extensive procedure, such as excision, on the same lesion, or when it is taken from a separate lesion. A biopsy done to assess margins or verify resectability is not reported. The operative note should state the reason for each specimen and its site.

Question 14

What is the difference between debridement codes 11042 and 97597?

Accepted Answer

Surgical debridement codes 11042 to 11047 are chosen by the deepest tissue removed, with 11042 for subcutaneous tissue, while 97597 is selective debridement of an open wound. Medicare contractor guidance says the code reflects the level of tissue debrided, not the depth of the wound, and 97597 should not be reported with 11042 to 11047 for the same wound. Notes need wound size, depth and the tissue removed.

Question 15

Can a surgeon bill an incidental appendectomy?

Accepted Answer

Not for a normal appendix. The NCCI policy manual says a medically necessary appendectomy may be reported separately, but an incidental appendectomy of a normal appendix during another abdominal procedure is not separately reportable. A hernia repaired at the site of the incision for an open or laparoscopic abdominal procedure is also not separately reportable. The operative note should state the indication, because medical necessity is what separates the two.

Question 16

Can a surgeon bill critical care during the global period?

Accepted Answer

Yes, but only when the critical care is unrelated to the surgery. Medicare may pay 99291 and 99292 in a global period when the patient is critically ill and the care is above and beyond and unrelated to the specific injury or procedure, for example in trauma or burn cases, and it asks for modifier FT. Care of a complication that does not need a return to the operating room stays in the global package.

Question 17

How much does general surgery billing cost?

Accepted Answer

Most billing companies charge a percentage of the revenue they collect, and published industry ranges commonly fall between 4 and 8 percent, with some offering flat monthly fees. The rate depends on claim volume, payer mix, how much work is included, such as coding, authorization and credentialing, and the state of your accounts receivable. We quote after reviewing your volume and payer mix.

Question 18

What is the difference between modifier 58 and modifier 78?

Accepted Answer

Modifier 58 is for a planned, staged or more extensive procedure related to the first one, during the global period. Modifier 78 is for an unplanned return to the operating room for a related complication, and payers generally pay only the intraoperative portion without starting a new global period. Under Medicare's global surgery rules, a complication that does not need the operating room is included in the surgeon's payment. Commercial payers set their own rules, so we check each policy.

Question 19

Are assistant surgeons paid?

Accepted Answer

Only for procedures where the payer allows an assistant. Medicare publishes an indicator for each procedure that shows whether an assistant may be paid, and commercial plans have their own lists. The modifier depends on who assisted: 80 or 82 for a physician and AS for a non physician provider. We check the rule before the case so the claim is not denied afterward.

Question 20

How do you bill a screening colonoscopy that becomes diagnostic?

Accepted Answer

When a screening colonoscopy finds a polyp that is biopsied or removed, the claim is billed as a diagnostic or therapeutic procedure with a screening modifier. Medicare uses PT and many commercial plans use 33. The modifier changes how the patient's cost sharing is applied, so we follow each payer's rule and make sure the diagnosis codes match.

Question 21

Do you handle prior authorization for elective surgery?

Accepted Answer

Yes. Many plans require approval for elective operations such as hernia and gallbladder surgery, and for advanced imaging. For plans covered by the federal prior authorization rule (CMS-0057-F), payers must decide within 72 hours for urgent requests and 7 calendar days for standard ones. We request approval when the case is booked and track it to a decision.

Question 22

What do you need from us to get started?

Accepted Answer

EHR or practice management access, your payer list and fee schedules, your recent denial reports, and a list of surgeons and sites. We usually begin with an audit of surgical claims and open global periods, because that is where the fastest gains are.

Question 23

What should a general surgery practice look for in a billing company?

Accepted Answer

Choose a team that understands the difference between open and laparoscopic operations, tracks every global period, holds excision charges until pathology is back, and handles authorization for elective cases before the date is booked. Ask how denials are reported and fixed, and whether coders are certified. DrCareMSO gives each general surgery group certified coders and a monthly denial and collections report.

Question 24

How do general surgery billing services handle hernia repair claims?

Accepted Answer

A hernia claim is only as accurate as the operative note. We confirm that the note states the total defect size, whether the hernia was reducible or incarcerated, and whether it is a first repair or a recurrence, then check that mesh is not billed as a separate line and that any mesh removal is added correctly. Authorization is requested before the date is booked when the plan requires it.

Question 25

Do you bill for gallbladder, appendix, breast and colon surgery?

Accepted Answer

Yes. We bill for gallbladder and appendix surgery, hernia repair, bowel and colon operations, breast biopsy and breast surgery, skin and soft tissue excisions, thyroid and endocrine operations, and endoscopy. Each has its own global period, approach rules and pathology timing, and we set those up for your surgeons before the first claim goes out.

Question 26

How do you manage billing for emergency and on call general surgery cases?

Accepted Answer

Emergency cases often arrive with missing insurance details, so we collect and verify coverage after the visit, link the consult and the operation correctly, and track the global period from the date of surgery. Trauma, auto and workers compensation cases get their own follow up track so claims are not lost while liability is sorted out.

Question 27

How do you reduce denials for general surgery claims?

Accepted Answer

We check coverage and authorization before the case, code from the completed procedure in the operative note, hold excision charges for the pathology report, apply bundling and global period rules before submission, and correct rejections the same week. Each month we group the denials that remain by cause and fix the source so they stop repeating.

Question 28

How do I choose a general surgery billing company?

Accepted Answer

Look for coders trained in general surgery claims, a plan for authorizations before the case or study, denial follow-up that continues until the claim is paid or appealed, and a monthly report you can read without a billing background. Ask who owns the payer deposits (they should go to your account) and ask to see a sample report before you sign.

Question 29

Is outsourcing billing a good fit for a small general surgery practice?

Accepted Answer

Often yes. A small practice carries the same payer rules as a large one, but with fewer staff to track hernia, gallbladder, bowel and endoscopy cases. Outsourcing replaces a part time billing hire with a team that works the claims every day. The right choice depends on your volume and how much time your staff spend on denials today, and we can look at your numbers with you on the first call.

Question 30

What reports will I receive from a general surgery billing company?

Accepted Answer

We send a monthly report that shows what was billed and paid, what is still open and why denials happened, grouped by cause so the source can be fixed. You can also ask for the payer mix and the oldest unpaid claims. Report details are agreed when you start, so you only get what you will use.

General surgery medical billing, from hernia repair to colonoscopy

What does a general surgery billing company do?

Where general surgery claims lose money

Laparoscopic cases that turn into open cases

Hernia repairs paid below their value

Excisions that wait on pathology

Assistants, co-surgeons and elective approvals

What we bill in every general surgery claim

Gallbladder, appendix and bowel

Hernia repair

Breast, skin and soft tissue

Endoscopy

Visits around surgery

Three facts decide how a hernia repair is billed

How we run general surgery RCM

Verify coverage and approval rules

Capture the case at the source

Code from what was completed

Close the charge after pathology

Submit, work denials and fix the cause

Why general surgery practices choose DrCareMSO

Certified coders for general surgery claims

Approvals before the case is scheduled

Every denial worked to payment

A monthly report in plain language

One surgical group, three leaks, fixed

Before

After

General surgery billing questions

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