As a general surgeon, you have some of the most complex billing processes among all medical professionals. With a multitude of fee codes to choose from and an even larger list of potential diagnoses, there are plenty of decisions you’ll need to make when billing each service. Unlike other medical specialists, surgeons typically bill fewer procedures at a higher dollar amount, making it extra important to bill for your time correctly. Fortunately, there are plenty of doctors who have been in your shoes! We’ve put together a guideline of some of the most commonly used billing facts for general surgeons.
General Guidelines and Criteria
- Unless specifically indicated in the fee code, your fees for surgical procedures include both the surgical procedure itself and the in-hospital post-operative follow up. This also includes wound care and the removal of sutures by the surgeon or their associate.
- The normal postoperative period included in the surgical fees is 14 days, and the surgical fees you bill will include all of the concomitant services you need to perform the service, such as preparing the operative site, incision, exploration, reviewing diagnostic test results and lab services, and consulting the patient and their family before and following the surgery.
- If you need to perform services in the hospital in the 14 days following the procedure that go over and above the concomitant services necessary for the operation, you may be able to bill these services separately from the inclusive surgical fee. This is unusual, however, and a note record is required.
Incidental and Similar Procedures
- If you’re performing two or more similar procedures (including bilateral procedures) under the same anaesthetic, or when two procedures are performed in the same general area (either from the same incision, an extension of that incision, or separate incisions) the procedure with the higher fee gets claimed in full, while the second procedure are reduced to 50%, unless otherwise indicated.
- Incidental procedures – like a surgery which would not have been performed in the absence of the primary procedure, such as an appendectomy during an abdominal surgery or the removal of a cyst during a gynecological procedure – are considered part of the original procedure that was planned, and you will not be able to charge for them.
- When you’re performing two or more procedures through separate incisions and under the same anaesthetic, if you need to reposition or re-drape the patient (or if there is more than one separately draped operating field required), then you can bill in full for the procedure with the greater listed fee plus 75% of the additional procedures, unless otherwise indicated.
- Procedures listed as ‘extra’ in the payment schedule can be claimed at the full fee, even when they’re performed with other surgical procedures (unless the payment schedule says otherwise).
Surgical Teams
- If two procedures are performed under the same anaesthetic by two surgeons, and both procedures are (or should be) within the competency of either surgeon based on their specialty, the total fee claimed for the surgery by both doctors can’t exceed the amount that would be payable if it had been performed by one surgeon plus one assistant’s fee.
- Unless the procedure has team fees that are specifically listed in the payment schedule or where you could reasonably expect to apply one, two procedures under the same anaesthetic, performed by two surgeons whose specialty skills are required for the operation, should be billed as if the procedures were performed in isolation. Keep in mind that you will not be eligible for assistant’s fees in these cases, unless the procedures take place consecutively instead of concurrently.
Staged Procedures, Abandoned Procedures, and Intra-Operative Injuries
- Unless there is a specific staged surgical procedure in the Payment Schedule, staged surgical procedures performed under separate anaesthetics can only be billed up to a maximum of 150% of the listed fee. However, emergency procedures that need to be followed up with a definitive surgical procedure for the same problem (for example, a cholecystostomy followed by a second cholecystectomy at a later date) should be claimed at the full listed fee.
- Surgical procedures that are abandoned before completion should be considered independently and paid according to the services that were actually performed.
- Any additional surgeries performed to correct inter-operative injuries that result from the complicated nature of the condition can be billed at 50% – these procedures must be supported by an explanation in a note record or an operative report.
- Additional surgeries performed to repair inter-operative injuries done by another surgeon can be billed at 100%.
Common Fee Codes
Although some fee codes are listed in the MSC payment schedule with prefix letters before them, when you’re entering these codes, all you’ll need to do is enter the number when you bill your claim – for example, V07707 would just become 07707, and CV70710 would be 70710. However, understanding the prefixes can help you to better understand the fee codes you’ll be using:
- The ‘C’ prefix designates fee codes where it isn’t required to indicate with a letter that a certified surgeon is needed to assist at the surgery.
- The ‘P’ prefix shows fee items that have been approved on a provisional basis and are now awaiting further review.
- The ‘S’ prefix designated fee codes where a surgical assistant fee is not payable.
- The ‘V’ prefix’ shows general surgery fee items exempt from the 14-day rule – these items can be billed over and above the post-operative care included within the first 14 in-hospital days.
Referrals
Referrals to you made from another doctor are usually followed by one of the two fee codes below:
- 07010 (Consultation): this fee code is used when a complete history and physical examination is conducted, along with any required review of X-ray or lab findings and a written report
- 07012 (Repeat or Limited Consultation): this fee code is used when a consultation is repeated for the same condition within 6 months of the last visit. It can also be used when you think the consultative service you’ve provided does not warrant the full consultation fee.
Continuing Care by Consultation:
Once a patient has been referred to you, you can use the following codes as you continue to provide care:
07007: Subsequent office visit
07008: Subsequent hospital visit
07009: Subsequent home visit
07005: Emergency visit when specially called.
This fee will not be paid if it is used in addition to out-of-office premiums and will not be not paid if the service provided is within 10 post-operative days from surgical procedure. Note: Claim must state time service was rendered.
07006: Directive care in emergent surgical conditions.
This is limited to 2 services per calendar week when medically required by the patient’s condition. This code should be used when further resuscitation and assessment is medically required in preparation for surgery and for the management of conditions like acute pancreatitis, which do not always progress to surgical intervention.
71008: Post-operative visit, in-hospital (1 – 14 days post-operatively).
This code is restricted to General Surgeons whose most recent specialty is General Surgery. You should not bill this item for “operation only” procedures – for those, you would use 07008 (subsequent hospital visit), or other appropriate fee item. For visits outside of the 1 – 14 days time frame you should also bill 07008 or another more appropriate item. This is not billable on the day of the procedure and is only paid once per day per patient, restricted to surgical fee items with a “V” prefix.
71015: Pre-Operative Assessment.
This is billed when a patient is transferred from one surgeon to another for surgery due to external circumstances. In this case, you’ll need to include a review of the patient’s medical records, as well as perform the appropriate physical exam, provide your written opinion, and obtain informed consent from the patient. Since this is similar to a consultation, this fee code is not payable to any physician who has billed a consultation with the patient for the same issue in the past six months. A maximum of one pre-operative assessment per patient, per procedure, must be followed, and fees can only be paid to the surgeon performing the procedure.
71010: Complex consultation for management of malignancy
71017: Special office visit for new diagnosis or recurrent malignancy.
This is payable only to the General Surgeon who is the most responsible physician in treatment of the malignancy – it is applicable to both new and recurrent malignancy, but the malignancy must be histologically confirmed. This is not to be billed for non-melanoma skin-carcinoma, and is only payable when it follows a visit from the same practitioner within the last 365 days.
70127: Closure or radical resection requiring a free split thickness skin graft (extra)
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- greater than 65cm² on trunk
- greater than 25 cm² on extremities or head/neck
Telehealth Service with Direct Interactive Video Link with the Patient:
While providing telehealth services might not be too common among surgeons, there are some fee codes that can be used when you’re providing service over the phone or a video call:
70070: Telehealth Consultation.
Like a regular consultation, these include a complete history and physical examination, a review of X-ray and laboratory findings if required, and a written report.
70072: Telehealth repeat or limited consultation.
Like in the normal fee code, these apply where a consultation is repeated for the same condition within six months of the last visit by the consultant, or where you feel the service does not warrant a full consultative fee
70077: Telehealth subsequent office visit.
70078: Telehealth subsequent hospital visit.
70076: Telehealth directive care in emergent surgical conditions – per visit.
These are limited to 2 services per calendar week when medically required by the patient’s condition, and are payable when further resuscitation and assessment is medically required in preparation for surgery. They can also be used for the management of conditions such as acute pancreatitis which do not invariably progress to surgical intervention.
70080: Telehealth Complex consultation for management of malignancy.
70087: Telehealth Special office visit for new diagnosis or recurrent malignancy.
Like in fee code 71017 above, these are payable only to the most responsible General Surgeon treating the malignancy, applicable to both new and recurrent malignancy (that is confirmed histologically) and not payable for non-melanoma skin carcinoma.
Trauma Assessment and Support Fees
All trauma assessment and support fees include the following:
| Fee Code | Description | Qualifiers |
| 10087 | Trauma Team Leader – Initial Assessment, Secondary Survey and Support |
|
| 10088 | Trauma Team Leader – Tertiary Assessment (after 24 hrs. and before 72 hrs.) |
|
| 10089 | Trauma Team Leader Subsequent Hospital Visit (Days 3 – 15 inclusive) |
|
Surgical Modifiers
The following modifiers can be used on top of surgical fee codes when specified. Out of office hours operative surcharges (like the ones in fee codes 01210, 01211, and 01212) cannot be paid on top of the modifier.
07001: Age 75+ Surgical Surcharge
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- Payable only once when multiple procedures are performed under the same anaesthetic, and payable with the following fee codes: 07027, 07061, 07072, 07075, 07076, 07082, 07108, 07109, 07110, 07111, 07112, 07143, 07147, 07150, 07360, 07363, 07366, 07368, 07402, 07403, 07404, 07405, 07406, 07407, 07408, 07409, 07410, 07411, 07412, 07413, 07431, 07432, 07433, 07434, 07435, 07436, 07437, 07438, 07440, 07441, 07442, 07443, 07444, 07445, 07446, 07447, 07448, 07449, 07452, 07455, 07460, 07470, 07471, 07472, 07473, 07474, 07475, 07479, 07481, 07482, 07497, 07498, 07516, 07522, 07528, 07536, 07560, 07561, 07562, 07565, 07567, 07569, 07570, 07578, 07580, 07588, 07589, 07597, 07600, 07601, 07603, 07610, 07623, 07624, 07626, 07627, 07628, 07630, 07632, 07634, 07635, 07636, 07640, 07641, 07643, 07645, 07646, 07647, 07648, 07649, 07650, 07651, 07654, 07658, 07660, 07662, 07663, 07665, 07666, 07672, 07675, 07676, 07677, 07678, 07679, 07683, 07685, 07687, 07689, 07698, 07699, 07703, 07705, 07706, 07707, 07711, 07714, 07725, 07732, 07733, 07740, 07741, 07743, 07744, 07745, 07749, 07756, 07758, 07769, 07771, 07776, 07782, 07789, 07790, 07796, 33321, 33322, 33323, 33324, 33325, 33326, 33329, 70084, 70155, 70158, 70159, 70162, 70163, 70165, 70166, 70168, 70169, 70470, 70471, 70473, 70477, 70478, 70479, 70500, 70530, 70531, 70532, 70533, 70534, 70535, 70536, 70538, 70539, 70540, 70541, 70542, 70544, 70545, 70601, 70602, 70603, 70605, 70606, 70607, 70620, 70621, 70622, 70625, 70626, 70627, 70628, 70629, 70630, 70631, 70632, 70633, 70635, 70637, 70641, 70642, 70643, 70644, 70645, 70646, 70648, 70649, 70650, 70660, 70665, 70666, 70668, 70671, 70672, 70674, 70676, 70680, 70683, 70694, 70695, 70698, 70700, 70701, 70702, 70703, 70704, 70705, 70712, 70713, 70714, 70715, 70716, 70718, 70720, 70721, 70722, 70725, 70726, 70727, 70728, 70731, 70740, 70742, 70743, 70745, 70747, 70748, 71282, 71290, 71292, 71293, 71380, 71530, 71535, 71536, 71537, 71538, 71539, 71540, 71541, 71542, 71543, 71546, 71548, 71549, 71551, 71606, 71607, 71608, 71609, 71610, 71611, 71612, 71613, 71614, 71615, 71616, 71617, 71618, 71619, 71620, 71621, 71622, 71623, 71624, 71625, 71650, 71651, 71681, 71682, 71684, 71686, 71700, 71703, 71704, 71705, 71706, 71708, 71709, 71710, 71712, 71713, 71714, 71716, 71717, 71718, 71719, 71720, 71721, 71722, 71725, 71746, 72572, 72600, 72601, 72620, 72622, 72623, 72624, 72625, 72626, 72631, 72632, 72633, 72634, 72635, 72636, 72640, 72641, 72644, 72647, 72648, 72650, 72651, 72652, 72653, 72656, 72657, 72658, 72659, 72660, 72665, 72666, 72669, 72670, 72671, 72672, 72673, 72683, 72703, 72704, 72705, 72711, 72713, 72714, 72715, 72720, 72721, 72723, 72725, 72726, 72727, 72728, 72729, 72730, 72731, 72732, 72733, 72734, 72735, 72736, 72737, 72739, 72740, 72741, 72743, 72745, 72751, 72755, 72760, 72762, 72763, 72765, 72767, 72769, 72770, 72775, 72788, 72789, 72794, 72795, 72796, 72797, 72798.
07003: Body Mass Index Surgical Surcharge (payable at 25% of listed fee for surgery performed)
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- Payable when the patient’s BMI is greater than 35. This information must be provided in the claim record to the tenth decimal (ie. 35.1) and recorded in the patient’s chart or operative report.
- Surcharge is payable to a maximum of once per operation, unless there are two general surgeons performing two surgeries simultaneously (in which case they are both eligible).
- When multiple procedures are performed in the same operation, the surcharge will apply to all eligible procedures at the prorated value – if you bill 100% of one procedure and 50% of another according to the rules for multiple procedures, you will be able to apply the surcharge on top of the value for both.
- This surcharge does not apply to surgical fee modifier 07001 (75+ surcharge) but can be paid in addition to it if the patient is both over 75 and obese.
- Surcharge is payable with the following fee codes: 07134, 07360, 07363, 07366, 07368, 07402, 07403, 07404, 07405, 07406, 07407, 07408, 07409, 07410, 07411, 07412, 07413, 07431, 07432, 07433, 07434, 07435, 07436, 07437, 07438, 07440, 07441, 07442, 07443, 07444, 07445, 07446, 07447, 07448, 07449, 07450, 07451, 07452, 07455, 07474, 07475, 07479, 07565, 07566, 07567, 07569, 07570, 07578, 07580, 07588, 07589, 07596, 07597, 07600, 07601, 07603, 07610, 07623, 07624, 07626, 07627, 07628, 07630, 07632, 07633, 07634, 07635, 07636, 07640, 07641, 07643, 07645, 07646, 07647, 07648, 07649, 07650, 07651, 07654, 07655, 07658, 07660, 07662, 07663, 07664, 07672, 07698, 07699, 07703, 07705, 07706, 07707, 07711, 07714, 07732, 07733, 07756, 07758, 07764, 07769, 07776, 70024, 70025, 70501, 70503, 70504, 70505, 70506, 70509, 70511, 70531, 70532, 70533, 70534, 70535, 70536, 70538, 70539, 70540, 70541, 70542, 70544, 70601, 70602, 70603, 70604, 70605, 70606, 70607, 70620, 70621, 70622, 70624, 70625, 70626, 70627, 70628, 70629, 70630, 70631, 70632, 70633, 70635, 70641, 70646, 70648, 70649, 70650, 70651, 70660, 70661, 70665, 70666, 70668, 70670, 70671, 70672, 70694, 70695, 70696, 70698, 70700, 70701, 70702, 70703, 70704, 70705, 70710, 70711, 70712, 70713, 70714, 70715, 70716, 70717, 70718, 70720, 70721, 70722, 70725, 70726, 70727, 70728, 70730, 70731, 70748, 71290, 71291, 71292, 71293, 71380, 71535, 71536, 71537, 71538, 71539, 71540, 71541, 71542, 71543, 71544, 71546, 71547, 71549, 71551, 71606, 71607, 71608, 71609, 71610, 71611, 71612, 71613, 71614, 71615, 71616, 71617, 71618, 71619, 71620, 71621, 71622, 71623, 71624, 71625, 71650, 71651, 71698, 71700, 71703, 71704, 71705, 71708, 71709, 71710, 71712, 71713, 71714, 71715, 71716, 71717, 71718, 71719, 71720, 71721, 71722, 71725, 71747, 72572, 72600, 72601, 72620, 72621, 72622, 72623, 72624, 72625, 72626, 72631, 72632, 72633, 72634, 72635, 72636, 72640, 72641, 72644, 72645, 72646, 72647, 72648, 72650, 72651, 72652, 72653, 72654, 72656, 72657, 72658, 72659, 72660, 72662, 72664, 72665, 72666, 72667, 72669, 72670, 72671, 72672, 72673, 72683, 72684, 72703, 72704, 72705, 72713, 72714, 72715, 72720, 72721, 72723, 72725, 72726, 72727, 72728, 72729, 72730, 72731, 72732, 72733, 72734, 72735, 72736, 72737, 72740, 72741, 72745, 72751, 72755, 72760, 72762, 72763, 72765, 72767, 72769, 72770, 72775, 72788, 72789, 72794, 72795, 72796, 72797, and 72798
Surgical Assistant/Second Operator Fees
Although it is unusual, there are rare situations where an assistant is required for a minor surgery – in this scenario, a detailed explanation of the need should accompany your claim. When a surgical assistant is required for two operations in different areas under one anaesthetic (whether or not they are performed by different surgeons), they are allowed to charge a separate assistant fee for each procedure, except in the cases of bilateral procedures, procedures within the same body cavity, and procedures on the same limb.
Keep in mind that visit fees are not payable with surgical assistance listings on the same day, unless each service is performed at a separate time – in this case, the claim should state the time each service was rendered. The following fee codes are used for surgical assistant or second operator fees, based on the total dollar amount of the procedure:
00195: surgical assistant for procedures less than $317.00 (inclusive)
00196: surgical assistant for procedures $317.01 to $529.00 (inclusive)
00197: surgical assistant for procedures over $529.00
00198: surgical assistance time, after 3 hours of continuous surgical assistance for one patient, each 15 minutes or fraction thereof.
70019: certified surgical assistance for one hour.
Used on occasions where it is necessary for one certified surgeon to assist another certified surgeon – an explanation of the need for this service is required as part of your claim, except in situations where the procedure is prefixed by a ‘C’ code. Time is calculated from the first patient/physician contact in the operating suite.
70020: certified surgical assistance exceeding 1 hour but less than 3 hours
Billable for up to and including 3 hours of continuous surgical assistance from a certified surgeon using 15 minute intervals (or fractions of them).
70021: additional certified general surgeon assistance time exceeding 1 hour.
This code is restricted to general surgeons and paid only in addition to fee code 70020. It is billed to a maximum of 8 full or partial 15 minute increments, and any additional assistance should be claimed under fee code 00197 or 00198. Must include start and end times.
Remember to include your start and end times in both the billing claim and the patient’s chart.
Wounds – General
The following fee codes are used in surgical procedures involving wounds:
13605: Opening superficial abscess, including furuncle
13610: Minor laceration or foreign body not requiring anesthesia.
This fee code is intended for use in the primary treatment of the injury – it is not applicable to changing the wound dressing or removing the sutures, but it is applicable to using steri-strips or glue to repair the laceration.
13611: Laceration requiring anesthesia
13612: Extensive laceration greater than 5 cm (maximum charge 35 cm).
This procedure must be done under anaesthesia and is billed per cm of the wound; the length of the laceration should be entered on the claim. This code is not billable by Plastic Surgery, Orthopedics or Otolaryngology.
13620: Excision of tumour of skin, subcutaneous tissue, or a small scar under local anesthetic, for wounds up to 5 cm.
13621: Any additional lesions removed at the same sitting (maximum of five per sitting) billed individually.
Wounds – Avulsed and Complicated
The following fee codes are used for more specific or complex procedures involving wounds:
06075: Lips and eyelids
06076: Nose and ear
70150: Complicated lacerations of tongue, floor of mouth.
06077: Complicated lacerations of the scalp, cheek and neck; the use of this fee code requires both:
- A layered closure, required when the defect would require too much tension for an acceptable primary closure – this must involve at least two layers of deep dissolving sutures to close off dead space and remove tension from the wound (deep cartilage closures are also considered layered closures) and,
A note added to the claim, indicating at least one of:
- Injuries involving necrotic tissue requiring debridement such that simple suture closure is precluded
- Injuries involving tissue loss such that simple suture is precluded
- Wounds requiring tissue shifts for closure aside from minor undermining or advancement flaps
- Skived, ragged or stellate wounds where excision of tissue margins is necessary to obtain 90 degree closure
- Contaminated wounds that require excision of foreign material
- Lacerations requiring layered closure and key alignment sutures involving critical margins of the eyelid, nose, lip, oral commissure or ear
- Lacerations into the subcutaneous tissue requiring alignment and repair of cartilage and layered closure.
In addition to these commonly used General Surgery fee codes, you can find additional fee codes here:
MSP General Surgeon Fee Code Lookup
Whether you’re new to the operating room or you’ve been working as a surgeon for years, mastering the MSP billing system isn’t always easy! By keeping a cheat sheet on hand, having open lines of communication with your billing staff, and making time to review your approved and rejected claims, you’ll be able to streamline your billing practice and avoid mistakes – which means less time spent on administration, and more with your patients.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
