Billing for plastic & reconstructive surgery is not general billing with a different code set. Reconstructive versus cosmetic determination, which decides whether there is a claim at all.
The functional-impairment documentation is the entire coverage argument, and photographs are frequently required before authorization.
At a glance
What drives the coding
Reconstructive versus cosmetic determination, which decides whether there is a claim at all.
What drives the payer behavior
The functional-impairment documentation is the entire coverage argument, and photographs are frequently required before authorization.
Coding
Assigned by certified coders from your documentation.
Reporting
Denials segmented by reason, payer, and provider.
Where plastic & reconstructive surgery claims actually fail
- Functional impairment not documented
- Procedure deemed cosmetic on review
- Prior authorization obtained for the wrong code
How we work it
We code from what your record documents and query you when it does not support a code, which in plastic & reconstructive surgery is where most of the avoidable exposure sits.
Denials are worked by cause rather than in queue order, so the same failure stops recurring instead of being re-worked every month.
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your current plastic & reconstructive surgery denials and aging.
Scope
A written scope and price before any work starts.
Transition
Coding and submission move across without a gap.
Report
Denial causes reported monthly, segmented by payer.
Plastic & Reconstructive Surgery — Frequently Asked Questions
Do you have coders who know plastic & reconstructive surgery?
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Yes. All coding is performed by certified coders, and specialty assignment is deliberate rather than incidental — reconstructive versus cosmetic determination, which decides whether there is a claim at all.
What makes plastic & reconstructive surgery claims deny most often?
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Three causes account for most of it: functional impairment not documented; procedure deemed cosmetic on review; prior authorization obtained for the wrong code. Each is a documentation or process failure rather than a coverage dispute, which is why we report denials grouped by cause instead of as a single rate.
How do payers behave differently for plastic & reconstructive surgery?
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The functional-impairment documentation is the entire coverage argument, and photographs are frequently required before authorization. That shapes which denials are worth appealing and where the front-end effort should sit, so it drives how we staff the work rather than being background color.
Do you guarantee higher collections for a plastic & reconstructive surgery practice?
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No. Payment is decided by the payer, and any firm promising a collection rate is describing something it does not control. We commit to the process and to six reported numbers you can check against your own system.
Who is responsible if a plastic & reconstructive surgery code is wrong?
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Codes are assigned from the documentation the practice provides, and where the record does not support a code we raise a query rather than infer intent. The clinical record and the certification of medical necessity remain the practice's, and claims go out under the provider's own National Provider Identifier.
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