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General Surgery Billing Services
Is Surgical Revenue Leaking Through Global Periods, Modifier Errors, and Missed Assistant Claims? Qualigenix codes and bills hernia repairs, cholecystectomies, colorectal resections, breast surgery, wound care and emergency cases for general surgeons in 48 states. Our surgical coders work at 98.9% coding accuracy with a 98.6% compliance and audit pass rate.
What General Surgery Billing Takes
General surgery billing takes three things: coding the operation exactly as the op note describes it, tracking each patient's 0-, 10- or 90-day global period, and using modifiers that tell the payer why a visit or second procedure is separately payable. Assistant and co-surgeon claims need their own rules. Qualigenix does this with surgical coders who read the full operative note. Call 786-259-0231 for a free billing audit.
01
Open, Lap & Robotic Coding
Open and laparoscopic versions of the same operation have different codes, and a conversion from lap to open is coded as the open procedure. Medicare pays nothing extra for robotic assistance; S2900 is accepted by some commercial payers and denied by many.
02
Pre-Surgery Authorizations
Elective hernia, bariatric and breast cases often need prior authorization with imaging and conservative treatment history. A missing approval can deny the surgeon, assistant and facility claims at once.
03
Global Period Tracking
During a 90-day global, routine post-op visits aren't paid. An unrelated visit is, with modifier 24. A return to the OR for a complication is billed with 78. Practices that don't track the global window miss these or bill visits that get denied.
04
Assistant & Co-Surgeon Claims
Medicare only pays an assistant at surgery for codes its fee schedule allows. Co-surgeons both bill with modifier 62, and each op note must show their part.
05
Benefits & Patient Estimates
Deductibles and coinsurance on surgical cases are large. Without a pre-op estimate, the practice collects less from the patient and later sends a bill they didn't expect.
06
Operative Note Gaps
A hernia repair since 2023 is coded by total defect size and whether the hernia was reducible, incarcerated or strangulated. If the note leaves out the measurement, the coder has to query or code low.
07
Bundling & Modifier Denials
NCCI edits bundle many same-session procedures. Modifier 59 or the X modifiers get denied when the note doesn't show a separate site, incision or session.
08
NCCI & Global Surgery Rules
CMS global surgery policy and NCCI edits set what's included in the surgical payment. General surgeons were the largest billing provider type for minor procedure improper payments in Medicare's 2025 audit sample, at a 24.0% improper payment rate.
How Qualigenix Recovers Each Surgical Revenue Gap
Qualigenix assigns certified surgical coders to your practice, and each gap has a fixed step.
Procedure-Level Coding
We code from the signed op note, including approach, defect size, lesion size and every separate procedure.
Authorization Before the OR
We submit and track authorizations with the imaging and treatment history payers request, and confirm approval before the case date.
Global Period Management
We track every patient's global window and apply 24, 25, 57, 58, 78 or 79 only when the note supports it.
Assistant Surgeon Billing
We check the fee schedule assistant indicator for each code before billing 80, 82 or AS, and match co-surgeon claims.
Pre-Op Benefit Verification
We verify coverage and give your staff a patient estimate before surgery.
Op Note Review
We query surgeons about missing measurements or findings within a day of the charge.
Denial Appeals
Surgical denials are appealed with the op note attached. Qualigenix overturns 79% of denials across its client base.
NCCI Edit Monitoring
We load quarterly NCCI updates and payer policy changes into our claim edits.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
General Surgery Coding by Procedure Family
Qualigenix codes general surgery cases across hospital, ASC and office settings.
Hernia Repair (49591–49618, 49650–49651)
Anterior abdominal hernia repair by defect size and hernia type, and laparoscopic inguinal repair.
COMPLIANCE
How We Keep Surgical Billing Compliant
Qualigenix keeps surgical billing compliant by coding each case from the signed op note, applying CMS global surgery rules for 0-, 10- and 90-day periods, and checking the fee schedule assistant indicator before any assistant claim goes out. Underbilling a return to the OR or an unrelated post-op visit loses earned revenue. Overbilling routine global care draws audits and repayment. We hold a 98.6% compliance and audit pass rate with an over- and undercoding rate under 2%. All work is HIPAA compliant, with patient data handled under strict security controls.
The op note sets the claim. We don't add to it, and we don't leave anything out.
0%
Audit Pass Rate
<0%
Variance Threshold
Why Qualigenix
0%
IMPROPER PAYMENT RATE
0%
FROM DOC GAPS
0%
FROM CODING ERRORS
$0M+
PAID IN ERROR
QUESTIONS BUYERS ASK
Qualigenix quotes each surgical practice after reviewing case volume, settings and payer mix. Most practices start with a free billing audit.
We code the procedure with its standard laparoscopic CPT code. Medicare pays nothing extra for robotic assistance, and we bill S2900 only to commercial payers that accept it.
Yes. Qualigenix bills the surgeon's professional claim for hospital, ASC and office cases, with the right place of service for each.
Yes. We work aged surgical claims by dollar value and filing deadline. Across our clients, Qualigenix has cut days in A/R from 54 to 36.
Yes, when they're separately payable. We bill unrelated visits with modifier 24, a decision for major surgery with 57, and related returns to the OR with 78. Routine post-op care stays inside the global payment.
We check the Medicare fee schedule assistant indicator for each code before billing 80, 82 or AS. Co-surgeons each bill with modifier 62, supported by their own op notes.
Yes. Qualigenix works in 133 EMR/EHR platforms and pulls op notes from hospital and ASC systems.
Qualigenix onboards new practices in 6 days on average.