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Plastic & Reconstructive Surgery Billing & Coding Services

Reconstructive plastic surgery can correct facial defects and body abnormalities caused by congenital disabilities, injury, disease, or aging. Usually, reconstructive plastic surgery aims to improve body function, create a more normal appearance, and improve self-esteem (this may also be called cosmetic surgery). Abnormal structures of the body may result from:

  • Injury
  • Infection
  • Developmental abnormalities
  • Congenital disabilities
  • Disease
  • Tumors

Due to multiple procedure payment reduction rules, co-surgeries, varying levels of wound repair codes (simple/intermediate/complex), and the need to use the right surgical and E/M modifier codes, plastic surgery medical coding can be confusing. Medical Coding errors cause delayed or denied reimbursements, leading to revenue loss and loss of time available for patient care. Plastic and reconstructive procedures are costly, and hence, the practices need to work hard and adhere to billing and coding guidelines.

RM Healthcare offers comprehensive plastic surgery coding Services to reduce claim denials and bring you maximum reimbursement for all Services.


RM Healthcare Expertise in Plastic & Reconstructive Billing & Coding

At RM Healthcare, we have a client base that extends across all 50 states, covers a wide range of hospitals, physician practices, and medical billing companies. Our team of billers & coders employ their experience and knowledge acquired through a decade of working with plastic surgeons in improving your revenue & accelerating growth. Our coders are proficient in CPRC, ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA, and certified by the American Academy of Professional Coders (AAPC).

Our coding experts are:

  • Experts in reading and understanding physician office notes and procedure note to apply correct ICD-10-CM, CPT®, HCPCS Level II, and modifier coding assignments
  • Evaluation and management (both the 1995 and 1997 Documentation Guidelines)
  • Possess adequate knowledge of the rules and regulations of Medicare billing, including (but not limited to) incident, teaching situations, shared visits, consultations, and global surgery
  • Capable of accurately coding for surgical procedures performed by plastic and reconstructive specialists such as scar revisions, facial repairs, cosmetic surgeries, etc.
  • Trained extensively on Medical terminologies & human anatomy and physiology

Applying best practices for Plastic and Reconstructive Surgery Billing and Coding

At RM Healthcare, we understand the challenges faced by Plastic and Reconstructive surgery providers. Rapidly changing policy rules, ICD updates, and your specialty's sensitive nature can make the billing and coding Services complex. Our certified billers and coders are well-versed in the nuances of billing for plastic and reconstructive surgery procedures. We understand the differences between cosmetic and medically necessary plastic surgeries and the respective coding and reimbursement guidelines. We process your claims accurately, improve clean claims rate, and accelerate your cash flow.

We have built our approach by adhering stringently to coding guidelines & bests practices and applying modern technology. The RM Healthcareteam focuses on providing data-driven solutions that help reduce denials and increase revenue.

Our best practices in plastic & reconstructive surgery include :

  • Choosing appropriate ICD codes for neoplasm, breast-related issues, facial nerve disorders, different types of burns, and other disorders
  • Applying correct CPT codes for procedures including but not limited to the following:
  • Breast reconstruction—extensive discussion including DIEP flaps
  • Skin lesion procedures including injection, biopsy, shave, and excision
  • Nasal procedures including rhinoplasty, nasal valve stenosis repair, and turbinates
  • Reporting Level 4 or Level 5 E/M Services with appropriate codes and modifiers and correctly applying consultation code
  • Adding appropriate modifiers for multiple procedures in a global period (51 and 59) co-surgeon (62) or assistant surgeon (80, 82) Services to optimize your revenue

Benefits of our Plastic & Reconstructive surgery Billing and Coding Services

We bring finesse and accuracy to our billing and coding Services while building a flawless reimbursement process for your practice. With diligent patient demographics entry, insurance verification, insurance authorizations, coding, billing, and payments reconciliation can add value to your organization. We ensure consistent accounts receivable follow-up and prior authorization to avoid claim denials. Our denial team's #1 priority is shifting your focus from denial management to denial prevention. Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process. We bring you a group of specialists who are:

  • Certification from The American Association of Professional Coders (AAPC)
  • Familiar with medical billing software such as Lytec, Medic, Misys, Medisoft, NextGen, athenanet, Cerner, McKesson, Open PMS, and many more
  • Coders trained in coding software such as EncoderPro, FLashcode, CodeLink
  • Being able to apply standard CPT, HCPCS procedure and supply codes, and ICD-CM diagnosis coding as per CMS guidelines
  • We maintain a successful track-record of processing medical bills with leading commercial carriers such as United health, WellPoint, Aetna, Humana, HCSC, Blue Cross Group, etc.
  • We provide uncompromised ability to negotiate successfully with Medicare and state-specific Medicaid policies.

Our clients typically see an improvement in revenue by 30% and a reduction in denials by a minimum of 10%. We achieve this by applying our expertise, process rigor, latest technology and by employing an excellently trained team.


RM Healthcare handles more than 250,000 patient support calls each month