General surgery billing for surgeons and surgical groups: office procedures, hernia, gallbladder, appendix, breast and wound surgery in the hospital or surgery center, the visits around each operation, and the global periods that decide what can be billed after it, worked inside the software you already use.
Surgical billing follows each operation through its global period. The visit where the decision to operate is made is billed with the right modifier, each procedure is coded from the operative note, multiple and assisted procedures are billed the way payers reduce them, and every visit after surgery is checked against the global period before it goes out.
$74M
in improper Medicare payments to general surgery in CMS’s 2025 review, a 3.6% improper payment rate
39.8%
of those general surgery errors were incorrect coding, and the other 60.2% were missing or insufficient documentation
A surgical claim carries more than the procedure code. A 90-day operation includes the visit the day before, the surgery and three months of follow-up care, so a visit in that time is paid only when a modifier shows it falls outside the package. Second procedures in the same session are paid at a reduced rate, an assistant is paid a fraction of the fee, and an unplanned return to the operating room is paid differently from a planned second stage.
The operative note and the global calendar decide the claim. That is why we check every procedure against its note and every visit against the patient’s open global periods before claims go out.
A surgical practice bills the visit before an operation, the operation itself and the care after it, each under different rules. Here is what goes wrong at each stage, and what we do.
Pays forNew patient and consult visits, including the visit where the surgeon decides to operate.
Where it breaks
What we do
Pays forHernia repairs, gallbladder and appendix surgery, breast procedures, debridement, endoscopy and other procedures, in the office, hospital or surgery center.
Where it breaks
What we do
Pays forVisits and procedures during a global period, when they fall outside the surgical package.
Where it breaks
What we do
Medicare gives each surgical code a global period of 0, 10 or 90 days. For a 90-day major operation, the package includes visits the day before and the day of surgery, the operation, routine follow-up for 90 days and treatment of complications that do not need a return to the operating room. A 10-day minor procedure includes the day of the procedure and the 10 days after it.
Modifiers show which services fall outside the package. Modifier 57 marks the visit where the decision for a major operation was made. Modifier 24 marks an unrelated visit during the global period and 79 an unrelated procedure, which starts a new global period. Modifier 58 marks a planned or more extensive stage, which also starts one, and 78 an unplanned return to the operating room for a related problem, which does not.
What we do: we keep a calendar of each patient’s open global periods, check every visit and procedure against it, and add the modifier the note supports, or hold the charge when the service is part of the package.
General surgery draws on codes from the skin to the abdomen, and on more modifiers than most specialties. These are the codes we see most, with what payers check on each.
| Code | What it covers | What payers look for |
|---|---|---|
| 99202 to 99215 | Office visits (E/M) | The level matches the decision making or time documented; modifier 25 with a same-day procedure only when the visit is separate. |
| 4756247563 | Laparoscopic cholecystectomy, without and with cholangiography | The approach and any imaging documented; 90-day global period. |
| 44970 | Laparoscopic appendectomy | The diagnosis and the approach; 90-day global period. |
| 49591 to 49596 | Anterior abdominal hernia repair, initial, by defect size | Total defect size, and whether reducible or incarcerated; mesh is included. |
| 4950549650 | Inguinal hernia repair, open and laparoscopic | Patient age, initial or recurrent, and the approach. |
| 1930138525 | Partial mastectomy, and axillary lymph node biopsy or excision | The side, and the separate node procedure documented. |
| 1104211045 | Debridement of subcutaneous tissue, first 20 sq cm and each additional | Depth and surface area of each wound. |
| 1006010061 | Incision and drainage of an abscess, simple and complicated | Complexity documented; 10-day global period. |
| 4323945378 | Upper endoscopy with biopsy, and diagnostic colonoscopy | Indication and findings, and screening rules where they apply. |
The visit the day before or the day of a major operation where the decision to operate was made.
A visit during the global period for a problem unrelated to the surgery. Modifier 24 vs 25 explained
A planned or more extensive procedure during the global period; starts a new global period.
An unplanned return for a related problem; no new global period.
A procedure during the global period unrelated to the surgery; starts a new global period.
Additional procedures in the same session, paid at a reduced rate. Our modifier 59 guide
Sources: CMS MLN booklet Global Surgery (MLN907166); Medicare Claims Processing Manual, chapter 12, section 40; Medicare NCCI Policy Manual, chapter III (integumentary system) and chapter VI (digestive system). CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you are a hospital-employed group whose billing the hospital handles, you do not need us. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, global period tracking, surgical modifiers, multiple procedure ranking and operative note coding, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load each payer's authorization and bundling rules and your fee schedules, list each patient's open global periods and the facilities where your surgeons operate, and agree how escalations work. Most practices are live within one to two weeks.
Visits and procedures are coded from the operative notes and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, global periods, modifiers and procedure ranking checked, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, site and service line, what was denied and why, authorizations pending, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your EHR is not shown, ask; the list grows as we onboard practices.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
Surgical claims are fewer and larger than in most specialties, and a single missed modifier can cost a whole case. A fee based on collections ties our pay to getting each operation, and the care around it, paid in full.
Summit Billing Solutions charges between 3% and 9% of monthly collections. Your rate depends on case volume, how many facilities your surgeons work in, office procedure volume and the state of the receivables, which we see in the free account review.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, global period tracking, surgical modifiers, multiple procedures and operative note coding, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Drive, Salem, NH 03079
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
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