General Surgery Billing in Florida- Revenue Cycle Tips for Complex Procedures.pdf

Learn how to navigate general surgery billing in Florida, focusing on common pitfalls and maximizing reimbursement opportunities.

1. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

1

General Surgery Billing in Florida: Revenue
Cycle Tips for Complex Procedures

General surgery billing represents one of the most challenging areas in medical revenue cycle
management. From multi-step procedures requiring multiple codes to complex modifier
applications and stringent documentation requirements, general surgeons in Florida face
unique obstacles that can significantly impact their practice’s financial health.
The complexity intensifies when dealing with procedures like hernia repairs, colorectal
surgeries, bariatric operations, and emergency interventions that involve multiple
components, extensive documentation, and frequent payer scrutiny. Even minor billing errors
can result in substantial claim denials, delayed payments, and lost revenue that directly affects
your practice’s bottom line.
At Medical Billers and Coders (MBC), we’ve spent over 25 years mastering the intricacies of
general surgery billing. Our specialized expertise helps Florida surgeons maximize
reimbursement for complex procedures while maintaining compliance with state regulations
and payer requirements. Whether you’re dealing with bundled payment issues, modifier
confusion, or mounting accounts receivable, understanding these revenue cycle strategies can
transform your practice’s financial performance.

2. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

2

Understanding General Surgery Billing Complexity in Florida
What Makes General Surgery Billing Challenging?
General surgery encompasses a vast array of procedures, each with unique coding and billing
requirements. Unlike specialty practices that focus on a narrow range of procedures, general
surgeons perform everything from routine appendectomies to complex trauma surgeries, each
requiring precise code selection and documentation.
The challenge multiplies when procedures involve multiple components performed during the
same operative session. Understanding which codes can be billed together, when to apply
modifiers, and how to properly document medical necessity becomes critical. Florida’s diverse
payer landscape—including Medicare, Medicaid, commercial insurers, and managed care
plans—adds another layer of complexity, as each payer has different policies regarding
bundling, global periods, and reimbursement rates.
Common Revenue Leakage Points in General Surgery
Revenue leakage in general surgery practices typically occurs at several predictable points in
the billing cycle. Incorrect code selection or failure to capture all billable components of
complex procedures leads to undercoding and lost revenue. Conversely, upcoding or
unbundling procedures that should be reported together can trigger audits and compliance
issues.
Modifier misuse represents another significant problem. Modifiers like 59 (Distinct Procedural
Service), 51 (Multiple Procedures), and 78 (Unplanned Return to Operating Room) must be
applied correctly to ensure proper reimbursement. Using them incorrectly results in denials or
reduced payments.
Documentation deficiencies cause perhaps the most frustration for surgeons. Payers
increasingly demand detailed operative notes, medical necessity justification, and evidence
that procedures weren’t performed for cosmetic purposes. When documentation doesn’t
support the codes billed, claims are denied regardless of how accurately they were coded.
Florida-Specific Considerations for General Surgery Billing

3. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

3

State Regulatory Environment
Florida has specific requirements that impact general surgery billing practices. The state’s
certificate of need (CON) program affects certain surgical facilities, while Florida-specific
licensure requirements influence which procedures can be performed in which settings.
Understanding these regulations ensures your billing practices align with state compliance
standards.
Florida’s insurance market also presents unique challenges. With a high percentage of
Medicare beneficiaries, managed Medicare Advantage plans, and a complex commercial payer
landscape, general surgery practices must navigate varying reimbursement methodologies and
authorization requirements across different patient populations.
Workers’ Compensation Considerations
Florida’s workers’ compensation system has specific billing requirements distinct from
traditional health insurance. General surgeons treating work-related injuries must understand
Florida’s fee schedules, reimbursement multipliers, and documentation requirements specific
to workers’ comp claims. Failure to follow these specialized billing rules can result in delayed
payments or claim denials.
No-Fault Insurance and PIP Claims
Florida’s no-fault auto insurance system requires general surgeons treating accident victims to
navigate Personal Injury Protection (PIP) billing requirements. These claims have specific time
limits for submission, unique fee schedules, and particular documentation needs that differ
from standard medical billing protocols.
Revenue Cycle Optimization Strategies for Complex Procedures
Strategy 1: Precise Procedure Code Selection
Accurate coding forms the foundation of successful general surgery billing. Complex
procedures often involve multiple CPT codes that must be selected based on the exact
techniques used, anatomical approaches, and extent of the surgery performed.

4. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

4

Best Practices for Code Selection:
For complex procedures like bowel resections, hernia repairs with mesh, or breast surgeries,
review the operative report carefully before coding. Identify all distinct procedural
components and determine whether they should be reported separately or if a single
comprehensive code applies.
Stay current with annual CPT code changes and updates. The American Medical Association
regularly adds, deletes, and revises codes that affect general surgery billing. Failing to use
current codes results in automatic claim rejections.
Understand the distinction between similar codes. For example, hernia repair codes vary
based on initial versus recurrent, reducible versus incarcerated, and whether mesh was
implanted. Selecting the wrong variation, even when the differences seem subtle, can cost
thousands of dollars per case.
Consider the global surgical package. Most surgical procedures include a global period
(typically 10 or 90 days) during which related follow-up care is bundled into the initial
procedure payment. Understanding what services are and aren’t included in the global
package prevents improper billing and ensures you’re not leaving money on the table.
Strategy 2: Mastering Modifier Application
Modifiers communicate important information about how, when, and why procedures were
performed. In general surgery, proper modifier use can mean the difference between full
reimbursement and claim denial.
Critical Modifiers for General Surgery:
Modifier 59 (Distinct Procedural Service) indicates that procedures normally considered
bundled were actually distinct and separate. This is one of the most scrutinized modifiers, and
improper use triggers audits. Use modifier 59 only when procedures are performed on
different sites, at different sessions, or involve different surgical approaches that clearly make
them distinct services.
Modifier 51 (Multiple Procedures) indicates that multiple procedures were performed during
the same operative session. Most payers automatically reduce payment for secondary

5. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

5

procedures when modifier 51 is used, so understanding payer-specific multiple surgery
reduction rules is essential.
Modifier 22 (Increased Procedural Services) allows billing for significantly greater work than
typically required for a procedure. However, this modifier requires extensive documentation
justifying why the procedure was more complex, time-consuming, or difficult than usual. Many
practices underutilize modifier 22, leaving significant revenue on the table for truly complex
cases.
Modifier 78 (Unplanned Return to Operating Room) is used when a patient requires additional
surgery during the global period for complications. This modifier allows separate payment for
the subsequent procedure, but documentation must clearly demonstrate the return was
unplanned and related to complications rather than staged procedures.
Bilateral modifiers (50, RT, LT) must be applied correctly for procedures performed on both
sides of the body or specific laterality. Improper use results in reduced reimbursement or
denials.
Strategy 3: Comprehensive Documentation Practices
Documentation serves two critical purposes in general surgery billing: it supports medical
necessity and substantiates the codes billed. Incomplete or inadequate documentation is one
of the leading causes of claim denials in surgical practices.
Essential Documentation Elements:
The operative report must include detailed descriptions of the surgical approach, specific
techniques used, anatomical findings, complexity factors, and any unusual circumstances
encountered. Generic templates or brief descriptions don’t provide sufficient detail to support
complex procedure codes or modifier usage.
Pre-operative evaluation and planning documentation establishes medical necessity. This
includes diagnostic test results, conservative treatment attempts (when applicable), and clear
explanations of why surgical intervention was necessary. For elective procedures, this
documentation is particularly critical to prevent medical necessity denials.
Intraoperative complications or unusual findings should be thoroughly documented. When

6. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

6

procedures take significantly longer than expected, involve unexpected anatomical variations,
or require additional work due to complications, detailed documentation supports the use of
modifier 22 for increased reimbursement.
Post-operative care documentation within the global period should be maintained even
though it’s not separately billable. This documentation supports the appropriateness of the
initial procedure and provides evidence if questions arise during audits or reviews.
Photographic documentation can be valuable for complex wound repairs, reconstructive
procedures, or cases involving unusual findings. Visual evidence strengthens medical necessity
arguments and supports coding decisions during reviews or appeals.
Strategy 4: Understanding Bundling Rules and NCCI Edits
The National Correct Coding Initiative (NCCI) edits define which procedure codes can be billed
together and which are considered bundled. Violating NCCI edits results in automatic claim
rejections or payment reductions.
Navigating Bundling Issues:
General surgery frequently involves procedures that may appear distinct but are actually
bundled according to NCCI guidelines. For example, exploratory laparotomy is typically
bundled into more definitive procedures performed during the same session. Attempting to
bill both separately results in denial of the exploratory procedure.
Understanding column one/column two edits helps predict bundling issues before claims are
submitted. Column one codes are the primary procedure, while column two codes are
component services typically included. Some edits allow modifier usage to override the
bundling, while others do not.
Stay current with quarterly NCCI updates. CMS regularly revises edits, and what was billable
separately last quarter might be bundled this quarter. Failing to update your billing practices
with each quarterly release guarantees claim denials.
For procedures not specifically addressed by NCCI edits, apply general bundling principles.
Components of a larger procedure, approach procedures that are necessary to perform the
definitive surgery, and services that represent standard preparation aren’t separately billable.

7. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

7

Strategy 5: Optimizing Authorization and Pre-Certification
Many complex general surgery procedures require prior authorization from insurance carriers.
Failure to obtain required authorizations results in claim denials regardless of how accurately
the claim is coded or how medically necessary the procedure was.
Authorization Best Practices:
Establish clear workflows for identifying which procedures require authorization from which
payers. Different insurance carriers have different authorization requirements, and these
requirements change regularly. Maintaining an up-to-date authorization requirement matrix
prevents surprises.
Submit authorization requests early in the process. Many payers require authorization several
days or weeks before the scheduled procedure. Last-minute authorization requests often
result in delays or denials that force procedure rescheduling.
Provide comprehensive clinical information with authorization requests. Include relevant
diagnostic test results, documentation of failed conservative treatments, and clear
explanations of medical necessity. Incomplete authorization requests face higher denial rates.
Obtain written confirmation of all authorizations and document authorization numbers in your
billing system. Verbal authorizations should be followed up with written confirmation, as
payers sometimes dispute whether authorization was actually granted.
Don’t assume authorization guarantees payment. Even with authorization, claims can still be
denied for coding errors, bundling issues, or documentation deficiencies. Authorization
confirms medical necessity but doesn’t override correct billing practices.
Strategy 6: Managing Global Period Complications
Surgical procedures include global periods—typically 10 or 90 days—during which routine
post-operative care is bundled into the initial procedure payment. Understanding global
period rules is essential for maximizing revenue while maintaining compliance.
Global Period Considerations:

8. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

8

Know which services are included in the global package. Routine post-operative visits, minor
complications managed without return to the operating room, and typical follow-up care
aren’t separately billable. Attempting to bill these services results in denials.
Understand when separate payment is appropriate. Unrelated services provided during the
global period, treatment of complications requiring return to the operating room (with
modifier 78), and new procedures for unrelated conditions can be billed separately when
properly documented and coded.
For staged procedures planned from the beginning, use modifier 58 (Staged or Related
Procedure) to indicate the subsequent surgery was planned and related to the original
procedure. This allows appropriate payment for the second surgery during the global period.
When multiple surgeons perform different parts of complex cases, use modifiers 62 (Co-
Surgery), 80 (Assistant Surgeon), or 82 (Assistant Surgeon when qualified resident not
available) to properly allocate payment among the surgical team.
Document separately identifiable evaluation and management (E&M) services provided on the
same day as surgery using modifier 25. This allows billing for significant, separately identifiable
E&M work beyond the usual pre-operative assessment.
Strategy 7: Effective Denial Management
Even with optimal billing practices, denials occur. How your practice responds to denials
directly impacts revenue recovery and long-term financial performance.
Denial Management Framework:
Categorize denials by type and root cause. Tracking whether denials result from authorization
issues, coding errors, medical necessity questions, or documentation deficiencies allows you to
identify patterns and implement preventive measures.
Respond quickly to denials. Most payers impose strict timeframes for appeals, often 30-60
days from the denial date. Missing appeal deadlines means forfeiting revenue that could have
been recovered with timely action.
Provide comprehensive responses to medical necessity denials. Include relevant medical

9. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

9

literature, clinical guidelines, and detailed explanations of why the procedure was medically
appropriate for the specific patient. Generic appeal letters rarely succeed.
Track appeal success rates by payer and denial reason. This data helps you understand which
denials are worth appealing and which represent systemic issues requiring process changes.
Consider secondary appeals when initial appeals fail. Many denied claims are successfully
overturned on second or third appeal, but practices often give up after the first denial.
Persistent, well-documented appeals recover substantial revenue.
Strategy 8: Leveraging Technology and Automation
Modern revenue cycle technology can significantly improve billing accuracy and efficiency for
general surgery practices. However, technology is only effective when properly implemented
and used strategically.
Technology Optimization:
Implement claim scrubbing software that checks for common coding errors, missing modifiers,
and NCCI edit violations before claims are submitted. This technology dramatically reduces
claim denials by catching errors in real-time.
Use charge capture systems that prompt for all billable components of complex procedures.
Many practices lose revenue simply because surgeons or staff forget to charge for ancillary
services, supplies, or minor procedures performed alongside major surgeries.
Integrate your practice management system with your EMR to streamline documentation flow
and reduce duplicate data entry. Seamless integration improves accuracy and efficiency while
reducing administrative burden on clinical staff.
Leverage analytics to identify revenue cycle bottlenecks. Regular reporting on days in A/R,
denial rates, collection percentages, and adjustment rates helps you spot problems early and
implement corrective actions quickly.
At MBC, our system-agnostic approach means we work seamlessly with whatever technology
infrastructure you currently have. You don’t need to change EMR systems or invest in new
software to benefit from our expertise—we integrate with your existing platforms.

10. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

10

How Medical Billers and Coders (MBC) Optimizes General Surgery
Revenue Cycles
Our Specialized Approach to General Surgery Billing
At Medical Billers and Coders, we understand that general surgery billing requires specialized
knowledge that goes beyond basic medical coding skills. Our team includes certified coders
with specific expertise in general surgery procedures, ensuring accurate code selection, proper
modifier application, and optimal reimbursement for every case.
With over 25 years in healthcare revenue cycle management, we’ve developed proven
methodologies specifically designed for the complexities of general surgery practices. We
don’t use generic billing approaches—our strategies are tailored to the unique challenges
surgeons face when billing complex, multi-component procedures.
Dedicated Account Management
Every MBC client receives a dedicated account manager who becomes an extension of your
practice. Your account manager understands your specific payer mix, common procedures,
and unique operational needs. This personalized approach ensures consistent communication,
rapid problem resolution, and strategic guidance tailored to your practice’s circumstances.
Unlike large billing companies where you’re just an account number, at MBC you work with
the same team members who develop deep knowledge of your practice. This continuity
results in fewer errors, better outcomes, and more efficient operations.
System-Agnostic Integration
One of the biggest concerns practices have when considering a billing partner is whether
they’ll need to change their EMR system. At MBC, we’re system-agnostic, meaning we work
seamlessly with your existing technology infrastructure—whether you use Epic,
eClinicalWorks, NextGen, Kareo, or any other platform.
This eliminates the cost, disruption, and learning curve associated with technology transitions.
You maintain your familiar workflows while gaining access to our specialized expertise and
proven billing methodologies.

11. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

11

Comprehensive Denial Management Services
Our denial management process goes beyond simply resubmitting rejected claims. We analyze
denial patterns to identify root causes, then implement preventive measures to stop denials
before they occur. This proactive approach reduces rework, accelerates payment cycles, and
improves your overall collection rate.
For existing denials, our team provides aggressive follow-up with detailed appeals that address
the specific reasons for denial. We don’t accept denials at face value—we fight for every dollar
you’re legitimately owed.
Old A/R Recovery Services
Many general surgery practices have significant revenue trapped in aged accounts receivable
that they believe is uncollectible. Our specialized Old A/R Recovery Services focus exclusively
on recovering these older claims through systematic follow-up, detailed research, and
strategic payer negotiation.
We don’t just work new claims—we actively pursue every dollar you’re owed, even from
claims that may be 90, 120, or 180+ days old. The revenue recovered from old A/R often
surprises our clients and provides immediate cash flow improvements.
Best Practices for Florida General Surgery Practices
Establish Clear Communication with Surgical Teams
Accurate billing starts in the operating room. Establish protocols for surgeons to communicate
unusual circumstances, unexpected findings, or complications that impact coding. When
surgeons document additional complexity or increased work, billers can apply modifier 22 or
other appropriate modifiers to maximize reimbursement.
Regular communication between clinical and billing staff prevents misunderstandings and
ensures everyone understands how documentation affects revenue. Brief monthly meetings
to discuss coding updates, payer policy changes, or common documentation issues pay
significant dividends.
Maintain Compliance with Evolving Regulations

12. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

12

Healthcare regulations constantly evolve, and general surgery practices must stay current with
federal, state, and payer-specific requirements. This includes HIPAA privacy rules, Medicare
fraud and abuse regulations, state billing regulations, and payer-specific billing policies.
At MBC, we maintain current knowledge of regulatory requirements and implement compliant
billing practices across all clients. Our 25+ years of experience means we’ve navigated every
major regulatory change in healthcare and can guide your practice through future changes.
Optimize Revenue Cycle Performance Metrics
Track key performance indicators that directly impact your practice’s financial health.
Important metrics include days in accounts receivable, first-pass claim acceptance rates, denial
rates by payer and reason, collection rates, and net collection ratio.
Regular monitoring of these metrics allows you to identify problems early and implement
corrective actions before small issues become major revenue problems. Benchmark your
performance against industry standards to understand where you stand relative to similar
practices.
Invest in Ongoing Training and Education
Medical billing rules change constantly, and what worked last year may not work today. Invest
in ongoing training for billing staff to ensure they stay current with CPT updates, NCCI edit
changes, modifier guidelines, and payer policy revisions.
When you partner with MBC, you gain access to our team’s continuous education and
expertise without having to invest in training your own staff. We handle the complexity of
staying current with changing regulations so you can focus on patient care.
Common General Surgery Billing Scenarios
Scenario 1: Emergency Procedures with Multiple Components
A patient presents with acute appendicitis and undergoes emergency laparoscopic
appendectomy. During the procedure, the surgeon discovers and repairs a concurrent
abdominal wall hernia. How should this be billed?

13. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

13

This scenario requires careful code selection and modifier application. The appendectomy is
the primary procedure, while the hernia repair might be separately billable depending on its
location, extent, and relationship to the appendectomy. Documentation must clearly indicate
the hernia was a distinct finding requiring separate surgical decision-making and work.
Modifier 59 may be appropriate if the hernia repair was truly distinct from the appendectomy
approach.
Scenario 2: Planned Staged Procedures
A bariatric surgery patient undergoes an initial procedure followed by a planned body
contouring surgery six months later, still within the global period. How is the second surgery
billed?
Staged procedures require modifier 58 to indicate the subsequent surgery was planned and
related to the original procedure. Documentation should include evidence that the second
surgery was anticipated from the beginning. Without proper modifier usage and
documentation, the second procedure may be denied as included in the global period of the
first surgery.
Scenario 3: Unplanned Return to Operating Room
A patient develops a post-operative complication requiring return to the operating room
during the global period. How is the additional surgery billed?
Use modifier 78 to indicate an unplanned return to the operating room for treatment of
complications. Documentation must clearly demonstrate the complication was unexpected
and required surgical intervention. The reimbursement for the return procedure is typically
reduced compared to a standalone procedure, but appropriate modifier usage ensures you
receive proper payment rather than having the claim bundled into the original surgery.
Scenario 4: Multiple Unrelated Procedures Same Session
A patient scheduled for cholecystectomy is found during pre-operative evaluation to have a
suspicious breast mass. The surgeon performs both the laparoscopic cholecystectomy and
breast mass excision during the same operative session. How should this be coded?
When unrelated procedures are performed during the same operative session, both can

14. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

14

typically be billed with appropriate documentation of the separate indications for each
procedure. The secondary procedure will likely receive reduced payment due to multiple
surgery reduction rules, but both procedures should be reported. Modifier 59 may be
necessary to indicate the procedures were distinct and unrelated.
Optimize Your General Surgery Revenue Cycle Today
The Cost of Inaction
Every day that your practice operates with suboptimal billing processes, you’re leaving money
on the table. Undercoded procedures, missed charges, denied claims, and aging accounts
receivable all drain resources that could be invested in practice growth, staff, or patient care.
The complexity of general surgery billing means even experienced practices likely have
significant revenue optimization opportunities. From modifier usage to bundling rules,
documentation practices to denial management, small improvements across multiple areas
can yield substantial financial gains.
Schedule Your Revenue Cycle Audit
Medical Billers and Coders offers comprehensive revenue cycle audits specifically designed for
general surgery practices. Our audit analyzes your current billing performance, identifies
specific opportunities for improvement, and provides projected financial impact based on our
proven methodologies.
During the audit, we’ll review your coding accuracy, denial rates, days in accounts receivable,
collection percentages, and payer performance. You’ll receive a detailed report with
actionable recommendations and clear next steps.
Schedule an audit today and discover how much revenue potential exists in your general
surgery practice. With our 25+ years of expertise, system-agnostic approach, and dedicated
account management, we can help you optimize every aspect of your revenue cycle.
Conclusion
General surgery billing in Florida presents unique challenges that require specialized
knowledge, attention to detail, and ongoing vigilance. From complex coding decisions to

15. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

15

Florida-specific regulatory requirements, successful revenue cycle management demands
expertise that goes beyond basic billing skills.
The strategies outlined in this guide provide a framework for optimizing your practice’s
financial performance. Precise code selection, proper modifier application, comprehensive
documentation, effective denial management, and understanding of bundling rules form the
foundation of successful general surgery billing services.
However, implementing these strategies while managing a busy surgical practice can be
overwhelming. That’s where partnering with specialists like Medical Billers and Coders makes
sense. Our dedicated team handles the complexity of general surgery billing so you can focus
on what you do best—providing excellent surgical care to your patients.
Don’t let billing complexity drain your practice’s revenue potential. With the right expertise,
systems, and strategies in place, your general surgery practice can achieve optimal financial
performance while maintaining full compliance with all regulatory requirements.
Ready to optimize your revenue cycle? Contact Medical Billers and Coders today to schedule
your comprehensive revenue cycle audit and take the first step toward maximizing your
practice’s financial health.
About Medical Billers and Coders (MBC)
Medical Billers and Coders (MBC) is a leading provider of medical billing, revenue cycle
management, denial management, and Old A/R Recovery Services. With over 25 years of
healthcare industry experience, we specialize in complex specialty billing including general
surgery. Our system-agnostic approach integrates seamlessly with your existing EMR, and
every client receives a dedicated account manager committed to their success. We help
Florida general surgery practices optimize their revenue cycles while maintaining full
compliance with federal and state regulations.
Schedule an audit today and discover how MBC can help your practice maximize
reimbursement for complex procedures.
Frequently Asked Questions About General Surgery Billing
What are the most common coding errors in general surgery?

16. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

16

The most frequent errors include incorrect modifier usage, unbundling procedures that should
be reported together, failing to capture all billable components of complex procedures, and
undercoding due to inadequate documentation review. These errors result in either claim
denials or lost revenue.
How long should I keep surgical documentation?
Federal regulations require maintaining medical records for at least six years from the date of
service or the patient’s last encounter. However, many states have longer retention
requirements, and Medicare contractors can request records for up to seven years. It’s
generally recommended to maintain records for at least seven years to ensure compliance
with all potential audit scenarios.
Can I bill for supplies used during surgery?
It depends on the billing setting and payer. In hospital settings, supplies are typically bundled
into the facility fee. In ASC or office settings, certain high-cost supplies and implants may be
separately billable, but this varies by payer. Medicare and most commercial payers have
specific policies regarding supply billing, so understanding payer-specific rules is essential.
How do I handle bilateral procedures?
Bilateral procedures should be reported with either modifier 50 (Bilateral Procedure) or
modifiers RT and LT (Right and Left) depending on payer preference. Most procedures
performed bilaterally receive 150% of the unilateral fee, but some payers have different
bilateral payment policies. Check payer-specific guidelines before submitting claims.
What documentation is needed for modifier 22?
Modifier 22 requires detailed operative notes explaining why the procedure was significantly
more complex than typical. Include specific information about unusual anatomy, extensive
adhesions, longer operative time, increased blood loss, or other factors that made the
procedure extraordinarily difficult. Also include comparison to typical procedure time and
complexity. Many payers require a written explanation with the claim submission.
How can I reduce claim denials?
Implement front-end processes including insurance verification, pre-authorization, and

17. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

17

eligibility checking before procedures. Use claim scrubbing software to catch coding errors
before submission. Ensure complete and accurate documentation supporting all codes billed.
Establish clear communication between clinical and billing staff. Track and analyze denial
patterns to identify and correct root causes.
Should I appeal denied claims?
Yes, appealing appropriate denials is essential for revenue recovery. Many denied claims are
overturned on appeal, particularly medical necessity denials where additional documentation
or explanation can support the service. However, focus appeal efforts on denials worth the
time investment and those where you have strong supporting evidence.
How does workers’ compensation billing differ in Florida?
Florida workers’ compensation has a specific fee schedule, different authorization
requirements, and unique documentation rules. Claims must be filed within specific
timeframes, and reimbursement is calculated using Florida’s fee schedule multipliers.
Understanding these specialized requirements is essential for practices treating work-related
injuries.

18. Visit our website: Click here

Follow us:




Call now 888-357-3226 (Toll Free)
[email protected]


Copyright © Medical Billers and Coders. All Rights Reserved

18

The Complete Guide to Wound Care Billing (eBook) – Grab Your Copy!