Common Mistakes in Surgery Billing and How to Avoid Them

 

Surgery billing is one of the most complex areas of medical billing, requiring attention to detail and a very deep understanding of the rules of coding. Unlike general medical billing, it involves multiple procedures, modifiers, and documentation requirements, making it more prone to errors. Errors may result in refused applications, postponed refunds, and financial burden on practices. Whether it's billing and coding, or general specialty procedures, accuracy and compliance are non-negotiable.

Incorrect Use of Modifiers

Misuse or missing modifiers constitutes one of the most prevalent challenges in surgery billing. Modifiers are essential because they provide additional details about a procedure, such as when multiple surgeries are performed, or a service is partially reduced or discontinued.The best way to avoid this is to ensure your billing team is fully trained in CPT and HCPCS updates and supported by a reliable medical billing program that can identify modifier errors before claims are submitted.

Incomplete or Inaccurate Documentation

Surgeons and podiatrists often perform multiple procedures during a single encounter, but if the operative notes are incomplete or unclear, payers may reject the claim. Inaccurate documentation also makes it difficult for coders to assign the correct codes, which directly impacts reimbursement. Encouraging surgeons to provide detailed operative notes and using a billing program with integrated EHR features helps eliminate these gaps.

Bundled and Unbundled Services Confusion

Surgical billing is complicated further by the challenge of determining when services should be bundled or billed separately. Overlooking unbundled services can cause revenue loss, while incorrect unbundling can trigger compliance risks. The National Correct Coding Initiative (NCCI) provides rules that practices need to follow, but these are constantly updated.

Payer-Specific Rules

Every insurance company has its own set of rules regarding the billing and podiatry billing and coding. A code accepted by one payer may be denied by another, leading to wasted time and resubmissions. Practices that do not keep up with these differences often face higher denial rates. Maintaining a database of payer guidelines and keeping staff updated with changes can help reduce such issues. Working with a billing partner who specializes in surgery billing is another effective way to stay ahead of payer requirements.

Overlooking Post-Operative Global Periods

Many claims are denied because practices bill for follow-up visits that fall within the post-operative global period. These visits are already included in the surgical package, so billing them separately results in denials. Understanding the global period for each procedure is crucial, and using a billing program that tracks post-op days can prevent errors. Visit 5 Star Billing Services today.

Patient Eligibility Oversights

Another common but costly mistake is failing to verify patient eligibility and prior authorizations before surgery. If a patient’s coverage has expired or authorization is missing, the claim will be denied, leaving the practice with unpaid balances. To prevent this, eligibility should be verified before scheduling surgery, and all authorizations must be documented and attached to claims.

Building a Stronger Billing Process

The billing demands precision, knowledge, and the right tools. By addressing issues such as modifier misuse, poor documentation, payer-specific rules, and eligibility oversights, practices can significantly improve their reimbursement rates. Leveraging advanced medical programs and seeking support from professionals who specialize in the billing and coding ensures fewer denials and a stronger revenue cycle. Visit 5 Star Billing Services today.