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General Surgery Billing compromises of several key surgical procedures that include gastrointestinal (GI) tract surgery, kidney, pancreas, thyroid, abdominal surgery, and liver transplant. General surgical billing has been exclusive with several coding guidelines affecting the code selection. According to the 2019 stats, general surgery medical billing and coding had to deal with 135 ICD-10 code changes and more than 69 CPT updates.
Legion Healthcare Solutions (LHS) has general surgery clients who dealt with many of these updates as a stepping process for future changes. Moving from initiating the billing and coding process, general surgery physicians have been able to implement a robust technological system to improve the changing medical billing and coding process.
“General Surgery Billing has been our focus area because even as the patient knows the underlying diagnosis and procedures and insurance companies support such system. It’s only when the claims are processed that most surgeons realize that a mistake has been made, outsource medical billing service assists in eliminating such mistakes.”
– Coding manager for General Surgery
General surgery is different compared to other surgeries, as the surgeon doesn’t need to code the complete surgical processes step-by-step and eliminate the need for in-depth documentation. General surgeons need to be aware that insurance companies might be providing a package-based solution for patients that cover everything or nothing. Prior authorization for such cases is imperative as it reduces the claim denials
To deal with coding errors and denials, LHS regulatory conducts coding audits for all our claims and looks for error-prone claims. Denials in general surgery occur due to code changes and no documentation of patient condition before surgery. Legion regularly trains its coders with detailed learning from coding experts from different regions.
General surgery involves various expertise of the surgeon and if they involve anesthesiologists and surgeons with different experience, in such case coding and billing with change. Such processes are usually not covered by an outsource billing company, however, at Legion we believe patient care should reciprocate with reimbursement.
Claims in general surgery are categorized based on two categories: With prior authorization and without prior authorization. With prior authorization rarely need a claim audit as an insurance company is informed about the procedure, however at the without prior authorization involves coding and billing audits by Legion billing managers.
LHS works with different EHR solutions and inducts even private insurance businesses with its platform solutions offering technological flexibility.