General surgery encompasses a wide range of procedures involving the abdomen, digestive tract, skin, soft tissues, and endocrine system. From appendectomies to hernia repairs and laparoscopic procedures, general surgeons perform high-risk, high-value services that require precise billing and coding.
However, due to complex documentation, bundling rules, global periods, and payer-specific policies, billing for general surgery is among the most intricate in healthcare. At Progressive RCM, we provide end-to-end general surgery billing services designed to reduce denials, optimize reimbursements, and ensure total compliance.
Challenges in General Surgery Billing
1. Complex Procedures
Surgeons often perform multiple procedures in one session — requiring correct use of modifiers (e.g., 51, 59, 22, 78) and accurate primary vs. secondary procedure designation.
2. Global Period Conflicts
General surgical procedures typically come with global periods (0, 10, or 90 days). Any post-op service billed within this window must include appropriate modifiers (24, 25, 58, 78, 79) or risk denial.
3. Bundling and NCCI Edits
The National Correct Coding Initiative (NCCI) bundles certain services, so billing must be done with awareness of unbundling rules and justifiable separation of procedures.
4. Medical Necessity
Surgeries must be backed by ICD-10 codes that justify the intervention, especially for payers like Medicare, which deny services lacking documented necessity.
5. Documentation Requirements
Precise and complete operative reports are essential for correct CPT code assignment, especially when multiple procedures or complications are involved.
Common General Surgery CPT Codes
We manage billing for a broad range of procedures including:
✅ Digestive System:
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44950 – Appendectomy
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47562–47564 – Laparoscopic cholecystectomy
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49505–49650 – Hernia repair
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43235–43239 – EGD with biopsy/removal
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45378–45385 – Colonoscopy procedures
✅ Skin and Soft Tissue:
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11400–11446 – Excision of benign/malignant lesions
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12001–13160 – Wound repair
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10120–10121 – Foreign body removal
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11042–11047 – Debridement procedures
✅ Breast, Endocrine, and Miscellaneous:
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19120 – Excision of breast lesion
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19301 – Partial mastectomy
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38500–38525 – Lymph node biopsy
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60240 – Total thyroidectomy
Key ICD-10 Codes for General Surgery
We ensure appropriate code matching for maximum approvals:
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K35.80 – Acute appendicitis
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K40.90 – Inguinal hernia
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K80.20 – Acute cholecystitis
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C50.911 – Malignant neoplasm of right breast
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L03.311 – Cellulitis of abdominal wall
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N60.29 – Fibrocystic breast disease
Our General Surgery Billing Services
At Progressive RCM, our team of certified coders and billing specialists understands the depth and scope of general surgery services and provides complete billing solutions, including:
✅ Insurance Verification & Prior Authorization
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Check patient insurance eligibility and coverage
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Obtain prior authorizations for inpatient admissions, outpatient surgeries, and high-risk procedures
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Confirm referral requirements
✅ Accurate Coding & Charge Entry
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Assign correct CPT, ICD-10, HCPCS codes
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Apply required modifiers (22, 51, 59, 24, 25, 58, 78, 79)
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Ensure alignment with documentation and NCCI edits
✅ Claims Submission & Scrubbing
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Submit clean claims within 48 hours
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Use advanced claim scrubbers to identify and fix errors
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Optimize code sequencing for maximum reimbursement
✅ Payment Posting & AR Management
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Post insurance payments and match with EOBs
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Identify and work on short payments, denials, and pending balances
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Monitor aging reports to reduce Days in A/R
✅ Denial Management & Appeals
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Analyze denial reasons
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Correct documentation or coding issues
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File appeals with supporting medical records and track until resolution
✅ Patient Billing & Support
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Generate detailed patient statements
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Offer secure online payment options
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Handle billing inquiries professionally and efficiently
✅ Reporting & Compliance Monitoring
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Monthly performance and revenue reports
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Track procedure profitability, claim rejection trends, and modifier usage
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Ensure full compliance with Medicare, Medicaid, and commercial payers
Why Choose Progressive RCM for General Surgery Billing?
✅ Specialty-Certified Coders
Our team is trained in surgical coding, global period billing, and modifier applications.
✅ Reduced Denials, Increased Collections
We catch issues before claims go out and work denied claims aggressively — improving your net collections rate.
✅ Full Transparency
You get real-time dashboards, monthly reporting, and a dedicated account manager.
✅ Custom Workflows
We align with your EMR system, practice model, and surgical facility — whether hospital-based or ASC.
✅ Audit-Ready Processes
We ensure documentation and coding meet standards for MACRA, MIPS, and payer audits.
Key Metrics We Track
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Clean claim rate
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First-pass resolution rate
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Average reimbursement per procedure
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Top denials by code and payer
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A/R over 60/90 days
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Modifier usage trends
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Days in A/R
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Patient collection rate
Tracking these KPIs allows us to identify trends and optimize your revenue cycle performance.
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Final Thoughts
General surgeons face enough challenges in the OR — billing shouldn’t be one of them. With complex procedures, bundling edits, and strict documentation requirements, the margin for error in general surgery billing is razor-thin.
At Progressive RCM, we specialize in making sure every claim you submit is accurate, justified, and optimized for payment. Let us handle your billing so you can focus on delivering life-saving surgical care.