Plastic & Reconstructive Surgery

Medical Billing And Revenue Cycle Management Solutions For Plastic & Reconstructive Surgical Facilities

Plastic and reconstructive surgeons perform a range of procedures and treatments to improve both the appearance of the patients and the function of the organs. Plastic and reconstructive surgery billing requires a comprehensive understanding of both cosmetic and medically necessary procedures, each with different coding, documentation requirements, and payer rules or regulations. At StafGo Health, we specialize in streamlining the billing process for plastic surgeons by providing tailored services according to their specific needs. Whether you work in a big hospital setup or in a small clinic, we are here to empower you with end-to-end RCM services that can enhance the cash flow and reduce the administrative burden on your office staff.

Essential CPT Code Management for Accurate Plastic & Reconstructive Surgery Billing and RCM

Plastic and Reconstructive Surgery billing requires precise use of CPT codes specific for cosmetic and reconstructive procedures, and our team at StafGo Health is well aware of the billing of frequently used codes such as 19357 (tissue expander placement for breast reconstruction), 19380 (revision of reconstructed breast), 14000–14302 (adjacent tissue transfer or rearrangement), 15770 (graft for facial nerve paralysis), 15830–15847 for panniculectomy and skin excision, 13101–13153 for complex wound repair, 15100–15776 for skin grafts and flaps, and 30400–30450 for rhinoplasty procedures. Our experts are also aware that the application of accurate modifiers (such as -59, -62, or 78) is essential to justify bundled or staged procedures and to support claims.

Why Outsource Medical Billing And RCM To Stafgo Health For Your Plastic & Reconstructive Surgical Practice?

Handling billing and revenue cycle operations for a plastic and reconstructive surgery practice can be highly complex due to the blend of cosmetic and medically necessary procedures, which require accurate coding and justification. By outsourcing your Medical Billing and RCM to StafGo Health, you can gain support in all aspects of the billing cycle. We help to get through pre-authorizations, ensure complete documentation, and minimize claim denials. With our support, you will have less administrative burden, quicker reimbursements, and improved compliance.

Common RCM Challenges Faced by Plastic & Reconstructive Surgery Practices

Distinguishing Between Cosmetic and Medically Necessary Procedures—These practices often face challenges in plastic surgery billing, clearly distinguishing between cosmetics, which are not covered by insurance companies, and medically necessary procedures like reconstructive procedures. This inappropriate classification can lead to claim denials or compliance risks.
Complicated Pre-Authorization Requirements - Complex reconstructive procedures usually require detailed documentation and prior authorizations. Failure to get approval on time and submission of incorrect clinical evidence can lead to delays or denied claims.
Precise Documentation Requirements—Plastic surgery procedures are complex and sophisticated in nature; they require very specific and detailed operative reports and medical justifications. Inappropriate or incomplete documentation can lead to downcoding, denials, or audits.
High Patient Responsibility and Out-of-Pocket Cost- In such a medical specialty, patients are liable to pay some or complete payment themselves for their services. In the absence of clear financial policies from the beginning and consistent follow-up, practices struggle with patient balances.
Inaccurate Coding and Modifier Usage - It is highly important to use the correct CPT codes and their modifiers (-59, -76, -78, -79, and -22), because procedures in this field can be complex and sometimes overlapping. To get fully reimbursed, practices should focus on accurate and consistent coding.
Mismanagement of Global Period- Surgical procedures generally have a global period of 10- or 90-day, and inaccurate tracking of post-op visits can lead to bundled denials.

Solving Your Plastic & Reconstructive Surgery Practices’ Challenges with StafGo Health

Excellent Coding for Cosmetic vs. Reconstructive Procedures- We have a team of certified coders who have comprehensive knowledge in coding, so they make sure of the selection of accurate CPT and ICD-10 codes, properly distinguishing cosmetic procedures from medically necessary ones. This reduces the chances of denial to a great extent.

Comprehensive Prior Authorization and Medical Necessity Guidance - Our team of experts manages the complete authorization process, from submitting detailed clinical documentation to detailed justifications, so that the surgeries are approved quicker and claims are not denied due to delays in the approval process.
Documentation Guidance & Compliance Errors—At StafGo Health, our team works closely with your providers to make sure that operative reports are appropriate and accurate medical records meet the standards set by insurance companies, which can help you to avoid downcoding, recoupments, or chances of audits.
Advanced Patient Responsibility Management - Our team helps you collect more money upfront and reduces the chances of unpaid patient bills by providing clear patient cost estimations. Easy-to-understand policies and Automated payment reminders.
Accurate Billing with Modifier and Bundling Expertise - Our billing team is well-versed in surgical coding, including appropriate use of modifiers and unbundling practices, which make sure every procedure is billed accurately and reimbursed in full.
Scalable Support as You Grow—Whether you work with one provider or with multiple surgeons across various locations, our team scales with you, offering high-level support without the burden of building internal infrastructure.