Surgical Coding Review
- Purpose: Identify up-coding, unbundling, and misuse of CPT codes and provide a basis to approve reimbursement for medical bills without over-payment
- Scope:
- Billing for the surgical procedure and post-operative care
- Reviewer: Unless otherwise stipulated by the customer, the reviewer will be a in active practice and experienced with the procedure in-question (operative and billing)
- Inputs:
- Surgical bills
- Operative and post-operative notes
- CPT codes manual
- Reviewer’s active clinical experience
- Discussion: None with the surgeon
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