SpecialtiesSurgical
How we see general surgery billing.
Reviewed by the VisMed surgical billing team
A surgeon’s claim for the procedure is usually right. What goes wrong is everything adjacent. The consultation that led to surgery, billable with modifier 57 the day before a major procedure. The follow-up visits inside the global period, which are not billable, and the unrelated visits inside it, which are, with the right modifier. The assistant at surgery, billable under specific rules by payer. The return to the operating room for a complication, billable with a different modifier from a staged procedure.
Each of these is a rule, and each rule is applied per case. A practice with generalist billers loses the decision visits, bills inside globals and gets recoupments, forgets the assistants and under-modifies the returns.
VisMed opens a case for every operation. It holds the global period, the decision visit, the assistant, the staged and unplanned returns, and closes when the global ends. Our coders apply modifiers from the operative report, not from memory.
Where general surgery practices lose money
The patterns we find in the aging and denial history before anything else changes.
Decision-for-surgery visit lost
The E/M that decides on a major procedure is billable the day before or the day of with modifier 57. Without it, the visit is bundled into the global and the work is free.Global period tracked badly
Follow-ups inside the global billed and recouped; unrelated problems inside the global not billed with modifier 24. Both patterns come from not knowing when each patient’s global ends.Assistant at surgery unbilled
Assistants, whether surgeons, residents or non-physician practitioners, are billable under payer-specific rules and modifiers. Practices without a process bill few of them.Returns to the operating room
Staged procedures, unplanned returns for complications and unrelated procedures in the global each take a different modifier and pay differently. Wrong or missing, the claim is denied or reduced.Multiple and bundled procedures
Hernia repairs with mesh, laparoscopic conversions and multiple procedures in one session follow bundling and reduction rules that decide the payment.
What we do differently for general surgery
Specialty-matched coders and a denials specialist, working inside your own system.
We open a case per operation
Each procedure gets a case with the global length, the decision visit, the assistant, and every subsequent encounter tagged as related or unrelated until the global closes.We take modifiers from the operative report
Our coders read the report and apply 22, 51, 58, 59, 62, 78, 79, 80 and the assistant modifiers from what was done, with a second review on complex cases.We hold assistant rules per payer
Which assistants are payable, for which procedures, with which modifier, is held per plan and checked before the claim leaves.We reconcile ASC and hospital schedules
Professional claims are reconciled to the operating room schedule and, where you own an ASC, to the facility claims, case by case.
What we bill
The procedure and code families your account team already works in.
General surgery billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed keep track of global periods?
Every operation opens a case with its global length. VisMed tags encounters during the global as related, which are not billed, or unrelated, which are billed with the right modifier. When the global closes, ordinary visits resume. Nothing depends on a biller remembering.
Can VisMed bill our assistants at surgery?
Yes. Payer rules differ on which procedures allow an assistant and which modifiers apply to surgeons, residents and non-physician practitioners. VisMed holds those rules per plan and bills the assistant from the operative report.
What is the difference between modifiers 58, 78 and 79?
Staged or planned related procedures in the global take 58, unplanned returns to the operating room for complications take 78, and unrelated procedures in the global take 79. They pay differently, and VisMed applies them from the report.
We operate at a hospital and an ASC we own. Can VisMed bill both?
VisMed runs professional claims for both sites and facility claims for the ASC through one team, reconciled to the schedule case by case.
Does VisMed bill the decision-for-surgery visit?
Yes, with modifier 57 when the visit on the day before or the day of a major procedure is where the decision was made and documented. It is one of the first things VisMed looks for on a new surgical account, because most practices have been giving it away.
Also in surgical
Orthopedics
Fracture care, implants and DME.
Neurosurgery
Multi-level procedures and co-surgeon billing.
Vascular surgery
Office-based labs and imaging supervision.
Thoracic surgery
Complex globals and critical-care overlap.
Plastic surgery
Reconstructive vs cosmetic separation.
Oral & maxillofacial surgery
Medical and dental claims on one case.
ENT
In-office procedures, audiology and allergy.
Ophthalmology
Eye-code vs E/M choice, injections and ASC.
Urology
Lithotripsy, in-office procedures and pathology.
OB/GYN
Global obstetric packages and gyn procedures.
Ambulatory surgery centers
Facility claims, implants and payer-specific groupers.
Anesthesia
Time units, modifiers and medical direction.
All specialties
The full list, in six groups
See where your general surgery practice is losing money. Free.
Six months of aging and denials, read by people who bill your specialty every day — quantified as monthly leakage with a recovery estimate. Yours to keep.
or write directly hello@vis.med