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