General Surgery Billing Guide: What Surgeons Must Know to Maximize Revenue

General surgery billing involves converting surgical procedures into standardized codes and submitting claims to payers. Yet in 2025, many practices still struggle with denials, bundling errors, and compliance changes that erode revenue. Claim denials pose a serious threat; 5–15% of general surgery claims are denied, potentially costing a typical $2 million practice $ 100,000 or more each year. Industry studies reflect this pain: approximately 15% of claims are initially unanswered, resulting in nearly $18 billion spent on appeals in 2023. This means that every rejected claim results in lost income and additional work. To stop the leakage, surgeons must understand evolving billing rules and best practices.

In this blog, we break down the billing process, common pitfalls, 2025 coding updates, and show how specialized services can help. 

Understanding the Basics of General Surgery Billing

General surgery billing is a multi-step process that involves documenting procedures, translating them into medical codes, and submitting claims to insurance for payment. It begins in the operating room, where surgeons record diagnoses, surgeries performed, and any devices or materials used. Next, medical coders review the clinical notes and assign the appropriate CPT (Current Procedural Terminology) and ICD-10 codes that describe those services. For example, a laparoscopic cholecystectomy has a specific CPT code, and any accompanying diagnoses (e.g., gallstones) get ICD-10 codes. Once coded, billers use those codes to prepare and send claims to payers. The biller also applies any necessary modifiers (e.g, for bilateral procedures or multiple surgeries) and follows payer rules.

The difference between billing and coding is key: coding is about accurately documenting what was done, while billing is about submitting claims and collecting payment. As AAPC explains, coding is “the process of translating medical reports into codes used within the healthcare industry.” In contrast, billing is “submitting and following up on claims with insurance companies to receive payment”. In practice, this means that coders must be familiar with the latest CPT, ICD-10, and HCPCS codes for surgical care. At the same time, billers must handle claim entry, payer follow-ups, patient statements, and accounting for reimbursement. Both steps are essential: even small coding mistakes (e.g., missing a code or modifier) can result in claim denials or underpayment.

Efficient billing also relies on good communication. For example, Transcure’s General Surgery billing and coding services emphasize tight EHR integration and staff training to keep documents and codes aligned. By understanding how coding drives billing and vice versa, surgical practices can lay the groundwork for full reimbursement.

Common Billing Challenges in General Surgery Practices

Surgeons face several unique challenges in billing that can zap revenue. Key issues include:

• High Denial Rates: Payers frequently flag claims involving complex surgery.  Simple errors, such as missing pre-authorizations, inaccurate codes or modifiers, or documentation issues, are frequently the cause of denials.  As previously mentioned, up to 15% of claims may be rejected initially. Each denial requires resubmission or an appeal, which delays payment.

• Procedure Bundling and Modifiers: Errors in procedure bundling can occur when multiple procedures are performed simultaneously.  For instance, it is frequently rejected when two surgeries are billed separately rather than using the appropriate modifier (such as Modifier 59 or 51).

• Global Period Confusion: Major surgeries come with global payment periods (e.g., 90 days) that cover postoperative visits. Many practices inadvertently bill for visits that are already included, resulting in recoupments. CMS has specific rules (updated for 2025) on when post-op E/M visits should be billed separately.

• Inadequate Documentation: Billing may be blocked because of inadequate operative notes or missing comorbidity information.  For example, the biller may not have sufficient rationale for higher-level codes if the surgeon fails to record all complications or co-surgeries. Incomplete documentation was flagged as a top coding error in general surgery.

• Regulatory Compliance: New compliance requirements, such as updated fee schedules and disclosures under the No Surprises Act, must also be balanced by surgeons. It is challenging to stay up-to-date with guidelines. Failing to meet changing rules (like immediate transparency of hospital costs) can incur penalties or write-offs.

• Patient Payments: High-deductible plans mean patients now bear a greater share of costs. If practices don’t effectively collect copays or payment plans, they also leak revenue on the patient side. Transparent billing processes and patient-friendly payment portals are essential, as practices often end up writing off patient balances due to difficulties in collecting payments.
  

Healthcare consultants emphasize that specialized surgical billing services can mitigate many of these issues. Outsourcing or consulting with experts in surgical coding has been proven to reduce denials and expedite payments. (See our analysis of top general surgery medical billing services to handle these challenges.)

2025 Coding Updates Every Surgeon Must Know

The code sets and rules surgeons use are updated annually. In 2025, several key changes will affect general surgery billing:

• New CPT Code Set (2025 Edition): The AMA reports 420 total updates in the CPT 2025 code set, including 270 new codes. Many of these recognize advances in technology and procedures. For example, the American College of Surgeons notes that cancer surgeries now have new codes: the old codes 49203–49205 have been replaced with more specific codes 49186–49190 for the excision and destruction of intra-abdominal tumors. Surgeons should review the new CPT book (or consult coding experts) to identify any new or changed codes that align with their practice. Other additions cover digital surgery and AI-assisted procedures. In short, you can’t rely on 2024 code knowledge; the CPT 2025 manual is mandatory reading for your coding staff.

• ICD-10-CM Revisions (Effective October 2024): The ICD-10 diagnosis codes have also been expanded. AAPC highlights that “nearly 250 new ICD-10-CM codes…and many deletions and revisions” took effect on October 1, 2024. These updates provide more granularity; for instance, new codes for obesity classes (E66.811–E66.813) and detailed gastrointestinal injuries (e.g., new codes for fistula and dehiscence) have been introduced. Surgeons must ensure these new diagnoses are captured in the chart. For example, if a patient has a chronic presymptomatic Type 1 diabetes, the chart must note that to use the new E10.A2 code. Missing a new specific code means leaving money on the table.

• Global Surgery Billing Guidelines. CMS’s 2025 final rule updated the Medicare global surgery policy. Notably, they clarified transfer-of-care modifiers. When one physician assumes part of a global episode, use modifiers 54, –55, or –56 to bill only the portion of care provided. CMS explicitly says modifier –54 (surgical care only) or –55 (post-op only) must be used when transferring care. Additionally, a new HCPCS add-on code, G0559, was created for postoperative visits conducted by a physician other than the one who performed the surgery. This acknowledges the additional work involved when a surgeon’s colleague handles follow-ups. General surgeons should train staff on these rules: forgetting the right modifier will trigger denials, especially in group practices where care is shared.

• Compliance and Regulatory Updates. Beyond coding, 2025 brings stricter enforcement of billing laws. For example, the No Surprises Act’s transparency and balance-billing bans are now in full effect, requiring clear patient communications. Medicare Physician Fee Schedule changes also affect reimbursement rates. Practices must update fee schedules and payer contracts accordingly. On the coding front, remember that all HIPAA and OIG compliance standards still apply; using an unlicensed codebook or failing to secure patient data in claims can result in fines.

Should You Outsource Your General Surgery Billing?

Deciding whether to handle billing in-house or outsource is a big question. Here are the key considerations:

Pros of Outsourcing General Surgery Billing:

• Expertise and Specialization: A dedicated general surgery billing company lives and breathes your codes. They are familiar with the nuances of surgical CPT/ICD coding, modifiers, and payer-specific quirks.

• Cost and Efficiency: Outsourcing can be a cost-effective solution. Compared to hiring and training internal coders and billers, many companies charge a percentage of collections. Transcure, for instance, promises a potential 25% reduction in billing expenses. You also save on overhead (such as software and office space) and turn that fixed cost into a variable one tied to revenue.

• Technology and Reporting: Billing firms often offer more advanced tools and analytics. For example, Transcure offers claim reports and real-time dashboards, enabling practices to spot revenue trends in real-time. Small practices gain access to enterprise-level RCM systems they couldn’t afford on their own.

• Focus on Patient Care: Outsourcing frees surgeons and staff from the burden of billing headaches. Instead of learning every payer update or chasing claims, you can focus on the patient care. The time saved can be reinvested in patient care or expanding services.

Cons of Outsourcing General Surgery Billing:

• Loss of Direct Control: You’re trusting an external team with sensitive data and revenue. You’ll need strong communication channels. Some surgeons worry about lag times or lack of oversight. It’s crucial to choose a partner with transparent processes and regular reporting.

• Upfront Vetting Costs: The search to find a billing company that suits you costs you both time and money. You need to verify multiple aspects, including case studies and compliance certifications, among others. This part is necessary, but it requires considerable effort.

• Variable Costs: At first, outsourcing seems to save you money, but some pricing models, such as a percentage fee, can increase your absolute cost as your practice grows. So, it is essential to make necessary calculations that suit your volume and budget.
  

Conclusion

General surgery billing in 2025 has become more detailed and demanding; however, getting it right can make a significant difference to your bottom line. Keeping up with coding changes and improving your billing process helps recover money that might otherwise slip through the cracks. Simple steps, such as clear documentation, accurate coding, effective audit utilization, and leveraging the right technology, can significantly protect your revenue.

You don’t have to manage everything by yourself. Partners like Transcure specialize in general surgery coding and offer innovative tools and expert support to handle the tricky parts for you.

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