Plastic Surgery Medical Billing Services Guide

Did you know plastic surgery medical billing services are growing in popularity around the US? You can capitalize on them and increase your revenue in no time. Read on to find out how plastic surgery billing is the answer to your financial problems.

ByadminonJanuary 31, 2024

Overview of Plastic Surgery Billing

Plastic surgery billing is a type of medical billing that bills cosmetic and reconstructive services. It involves coding and documenting a broad spectrum of plastic surgeries. These surgeries include rhinoplasty, breast augmentation, and interventions. You may conduct these surgeries after trauma or illness. This billing also manages insurance eligibility verification. You may have to conduct pre-authorization when necessary. Billing cosmetic procedures requires understanding their codes.

plastic surgery medical billing services
These codes are assigned to different procedures. Those procedures include facelifts, liposuction, and cosmetic injections. Plastic surgery billing often involves providing many procedures in a single session. You must have the expertise to handle that. Modifiers also have to be used to provide important details. These details include bilateral procedures and staged reconstructions. You also have to follow guidelines that distinguish between cosmetic and reconstructive surgeries.

Following guidelines increases reimbursements and prevents claim denials. Also, plastic surgery billing manages global periods. It provides follow-up care within initial reimbursements as well. Denial management and appeal systems are also used in billing. They can address claim denials. You can maintain your financial stability with them as well.

How Plastic Surgery Billing Helps?

plastic surgery medical billing services

Physical surgery medical billing services help hospitals a lot. They select accurate ICD codes for various patient cases. They usually involve neoplasm and breast-related issues. Other cases include facial nerve disorders and different levels of burns. This billing applies the CPT codes for such procedures. Some of those procedures include breast reconstruction using DIEP flaps. There are skin lesion procedures as well that include biopsy and excision.

You can also provide nasal procedures like valve stenosis and turbinate repair. Hand surgery is also a crucial surgery in case of accidents. You also have to provide evaluation and management services. These services are assigned Reporting Levels 4 and 5. They will be used alongside appropriate consultation codes and modifiers. Modifiers are also added for the global period, as well as co-surgeon and assistant surgeon services.

Benefits Of Outsourcing Plastic Surgery Services

plastic surgery medical billing services

    1. Billing and Coding Expertise

Outsourcing plastic surgery services ensures accurate billing and coding practices. Those practices are outsourced to expert medical billing companies. Such companies can assign precise codes to various cosmetic and reconstructive procedures. This way, you can reduce errors and increase reimbursements.

    2. Flawless Reimbursement

Outsourcing companies also follow a flawless reimbursement process. This process has a step-by-step workflow. Each step is conducted flawlessly for billing plastic surgery services. These steps include demographics entry, payment posting, and much more. These flawless steps enhance your financial efficiency. They also reduce the likelihood of reimbursement delays.

    3. Accounts Receivable Follow-up

Moreover, outsourcing companies consistently follow up on your accounts receivable. They address issues from all ends. This practice avoids delays and improves your financial stability. It also maintains a steady cash flow for your plastic surgery practice.

    4. Denial Prevention

You can also shift your focus from denial management to denial prevention. For this, you would have to outsource your plastic surgery billing services. It enhances your billing efficiency. You are also able to identify the root causes of your claim denials. Outsourcing companies can install preventive measures as well. These measures cut claim denials and increase your revenue.

    5. Certified Specialists

Most of the outsourcing companies have certified specialists. These specialists are accredited with reputable certifications. Their accreditations ensure a high level of billing skills. They can easily follow the set billing and coding standards. These features reduce the risk of any compliance issues.

    6. Medical Billing Software Familiarity

Outsourcing companies have billing specialists. They are familiar with many plastic surgery billing software. The software is ideal for billing plastic surgery services. The specialists can integrate the software with your physical surgery systems. This way, you can efficiently manage your patient data.

    7. Coding Software Training

Outsourcing companies have dedicated coding teams for each project. These teams are trained in the best coding software available. This ensures they assign accurate codes to your plastic surgery medical billing procedures.

The training increases their precision in coding. It also reduces the likelihood of errors. They can also ensure compliance with industry coding standards.

    8. Successful Track Record

Each outsourcing company usually has a successful track record. They also process plastic surgery bills of major hospitals. A successful track record demonstrates their ability to manage plastic surgery billing processes. They also ensure you receive full reimbursements for your plastic surgery medical billing services.

    9. Top-notch Negotiation Abilities

You can also make use of the excellent negotiating abilities of those companies. They can negotiate with insurance companies on your behalf. They can ensure ideal reimbursement rates for you. You can also get increased financial returns for your plastic surgery practice.

What Makes Our Plastic Surgery Billing and Practice Management Different

Our commitment to excellence in plastic surgery billing and practice management sets us apart. CloudRCM Solutions provides services tailored to your unique needs in plastic surgery practices. This ensures a level of precision and expertise higher than other medical billing companies.

    1. Specialized Focus on Plastic Surgery Billing

CloudRCM Solutions maintains a specialized focus on plastic surgery medical billing services. It allows us to better understand the details of medical coding and other processes. These processes are specific to plastic surgery practice.

    2. Usage of Advanced Technology

We use cutting-edge technology to bill plastic surgery services. This integration improves our billing processes. It also reduces errors. This way, we can increase the efficiency of our practice management.

    3. Customized Billing Solutions

We can recognize the unique needs of your plastic surgery practice. That data can be used to offer customized billing solutions. These solutions align with your specific challenges. This way, we can fulfill the requirements of your plastic surgery procedures.

    4. Commitment to Continuous Improvement

We are also committed to continuously improving your billing processes. Our billing experts stay informed of all industry updates. We adjust to the coding changes as well. This way, our reimbursement policies constantly evolve. And we can adapt our services to provide the best possible support for your plastic surgery practice.

    5. Transparent Communication and Reporting

We fully believe in keeping our partners in the loop. So we can always maintain transparent communication with you. Our billing professionals can provide detailed reports on their activity. They can also offer insights into your financial health.

These practices are parts of our transparent approach to keep you informed. With this, you can stay confident in our plastic surgery billing.

Challenges of Plastic Surgery Billing

plastic surgery medical billing services

Hospitals face a lot of challenges in plastic surgery billing. You should have knowledgeable billing specialists. The other option is to outsource your plastic surgery processes to billing experts.

    1. Complex Coding Requirements

Plastic surgery procedures involve many secondary services as well. They include anaesthesia, surgical procedures, and post-operative care. They have different coding and billing requirements. It can be difficult for you to manage them. You may even encounter errors and denied claims.

The codes for plastic surgery procedures are constantly updating. It is also challenging to stay updated and assign accurate codes. There are legal and ethical concerns raised as well. They are mostly about informed consent, patient confidentiality, and medical necessity. These issues can make coding more difficult.

    2. Prior Authorization

Insurance companies regularly conduct prior authorization. It determines if plastic surgery services are covered under insurance plans. It can be challenging for several reasons. Prior authorization for plastic surgery is complex and time-consuming.

You have to submit detailed medical records and documents to insurance companies. It takes a significant amount of time and effort. Many insurance companies also do not standardize their prior authorization process. It can lead to confusion and inconsistency for hospitals.

    3. Insurance Coverage Limitations

Insurance coverage is limited for plastic surgery. Most of its procedures are considered elective or cosmetic. They are not considered medically necessary. Insurance only covers plastic surgery if it is medically necessary.

An example is breast reduction surgery. Insurance may cover it if it is medically necessary. Surgery may treat chronic pain or discomfort in patients. It also corrects a condition known as gynecomastia in men.

Another example is eyelid surgery. An insurance company will only cover it if it is necessary. It can correct a condition called ptosis that impairs vision. But, insurers may not cover other plastic surgery procedures like breast augmentation or liposuction.

They are considered cosmetic and not medically necessary. In some cases, insurance may cover some of the costs if the procedure is considered both cosmetic and reconstructive.

Understanding Claim Denials in Plastic Surgery

plastic surgery medical billing services

The claims of plastic surgery medical billing services can be denied for various reasons. Let’s take a look at them in detail:

    1. Pre-Existing Conditions

A pre-existing health condition exists before patients get their insurance coverage. Such medical conditions can exist before plastic surgeries. They can impact the outcome of those procedures. They even pose a risk to patients during or after those surgeries.

Insurance companies may consider pre-existing conditions to be related to plastic surgery procedures. As a result, they are likely to deny the claims of those conditions. For example, a patient can have high blood pressure, diabetes, or heart conditions.

All these are pre-existing medical conditions. Insurance companies may deny claims if they believe plastic surgery could worsen those pre-existing conditions. The surgery could even pose a risk to the patient’s health.

Insurers may also ask you to evaluate patients before surgery. They may also use your medical documentation. Your documents can help them determine whether a pre-existing condition exists. They can also check whether the plastic surgery is medically necessary.

    2. Experimental or Investigational Procedures

Insurance companies consider some plastic surgery medical billing services as experimental or investigational. They do not think those services are medically necessary. The services may not be supported by clinical evidence. They are unlikely to be widely accepted in the medical community.

Such services may also be undergoing clinical trials. Their treatments have just not yet been proven to be safe and effective for a particular condition. As a result, insurance companies may just deny your claims. They make such decisions based on their medical policies.

This way, they can determine which procedures come under their coverage and which ones are experimental. Insurance companies can deny the coverage of experimental procedures. And your patients may have to pay the entire cost of those procedures.

You and your patients have the right to appeal the claim denials of such procedures. You can provide extra details and evidence to support their medical necessity.

    3. Post-Operative Non-Compliance

This is another common reason for claim denials in plastic surgery. A patient is given specific instructions during a plastic surgery procedure. They have to comply with them after the surgery. Compliance ensures a safe and successful recovery.

In case of non-compliance, those patients can experience complications. And their insurance claims for extra treatment may also be denied. For example, you may ask a patient to avoid strenuous exercise. They have to avoid it for several weeks after their surgery.

But they do not comply with your guidelines. They start exercising as per their workout routine too soon. As a result, one of their wounds opens up or an implant shifts. Their insurance company may argue that their non-compliance caused that complication.

And they may even deny coverage for treatments needed to address those complications. So, your patients must follow their post-operative guidelines. This can ensure a safe and successful recovery. They can also avoid claim denials by their insurance company.

What Are The New Plastic Surgery CPT Codes?

    1. CPT Code 15820

This code is assigned to a process named blepharoplasty. You have to surgically trim the excess skin from below the lower eyelid of your patients. This trimming improves the cosmetic appearance of their faces.

     2. CPT Code 23430

You can assign this code to the process of surgically cleaning the long tendon of the biceps. The tendon is cleaned from its damaged fragment. You have to fix it to the upper end of the humerus. This step improves the stability of those joints.

It also restores function to your patients with severe damage to the biceps tendon. The damage occurs due to recurrent shoulder impingement or degenerative changes in the shoulder joint.

    3. CPT Code 15836

The 15836 code is assigned to a removal process. You use it whenever you have to remove the excessive skin and subcutaneous tissue of the arm.

    4. CPT Code 19318

You can assign this code to the breast reduction procedure. This procedure removes excess breast tissue. The tissue can result from top scarring, calcification, or architectural distortion.

    5. CPT Code 14040

This code is important for repairing lesions. These lesions are present in different parts of the patient’s body. Some of them are the forehead, cheeks, chin, mouth, neck, and hands. Lesions are repaired with healthy tissues from an adjacent site.

The Bottom Line

Plastic surgery medical billing services code and document cosmetic and reconstructive procedures. Outsourcing them brings you billing expertise and certified specialists. Their challenges include complex coding, prior authorization, and insurance limitations.

Their claims can be denied due to some pre-existing conditions and non-compliance. Some of their CPT codes are assigned to blepharoplasty, breast reduction, and other procedures.

Contact us today and eliminate all your financial problems with plastic surgery billing.

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