Surgery Billing Errors: How to Review Your Surgical Bill
Surgical bills are complex and error-prone. Learn about assistant surgeon fees, global surgical packages, and OR time errors to save $500-$15,000.
Potential savings: $500-$15,000
Surgical procedures generate some of the highest medical bills, often running into tens of thousands of dollars. The complexity of surgical billing, with separate charges for the surgeon, assistant surgeon, anesthesiologist, facility, supplies, and recovery, creates abundant opportunities for errors. Studies show that surgical bills have among the highest error rates of any medical service category.
What Is Surgery Billing Errors?
Surgical billing revolves around the global surgical package concept. When a surgeon bills a procedure code, it includes the operation itself, local anesthesia, immediate post-operative care, typical follow-up visits within a defined period (0, 10, or 90 days depending on the procedure), and related complications. Charges for services already included in the global package should not appear as separate line items.
Common Billing Errors
An assistant surgeon fee (modifier 80) billed for a procedure that does not require an assistant. Medicare and most insurers publish lists of procedures that do not warrant an assistant surgeon. If no assistant was medically necessary, this charge may be erroneous.
Modifier 80 (assistant surgeon) on minor proceduresBilling separately for services that are included in the global surgical package, such as post-operative wound care, suture removal, or routine follow-up visits within the global period. These should not generate additional charges.
E/M visit codes (99212-99215) billed within 90-day global periodOperating room charges are typically billed in 15-minute increments. Errors occur when the billed OR time exceeds the actual time the patient was in the operating room. A one-hour surgery billed as two hours doubles the facility fee.
Billing for premium surgical supplies or implants when standard alternatives were used, or charging for supplies that are included in the facility fee or surgical package. Common examples include sutures, staples, and disposable instruments.
How to Spot These Errors on Your Bill
- 1
Request the operative report and compare the actual procedure time against the billed OR time.
- 2
Check if follow-up visits within 90 days of surgery are billed separately when they should be included in the global surgical package.
- 3
Verify whether an assistant surgeon was present and medically necessary for your specific procedure.
- 4
Look for surgical supplies billed separately that should be included in the facility fee.
- 5
Compare the surgical CPT code against what your surgeon described as the procedure performed.
Frequently Asked Questions
What is included in the global surgical package?
The global surgical package includes the procedure itself, local or topical anesthesia, digital nerve blocks, the immediate post-operative care on the day of surgery, typical follow-up visits (within 10 or 90 days depending on the procedure), post-surgical pain management, wound care, and treatment of routine complications. Services outside this scope, like unrelated conditions, can be billed separately with modifier 24.
How can I find out the actual OR time for my surgery?
Request your operative report and anesthesia record from the hospital. These documents record the exact start and end times for the procedure, anesthesia, and OR occupancy. Compare these times against the billed OR minutes on your itemized bill.
Should I pay for an assistant surgeon?
It depends on the procedure. Medicare publishes a list of procedures where an assistant surgeon is allowed, not allowed, or allowed with documentation. If your procedure does not typically require an assistant and no documentation supports medical necessity, you should not have to pay this fee. Check with your insurance company about their specific policy.
Upload Your Bill for Free Error Detection
Let us scan for these billing errors automatically
Analyze Your BillRelated Resources
Learn about the most common medical billing mistakes that could be costing you thousands of dollars.
A practical guide to disputing unfair medical charges and navigating the hospital billing appeals process.
Related Guides
Anesthesia Billing Errors: Common Mistakes and How to Fight Them
Anesthesia billing uses a unique time-based formula. Learn how to catch time unit errors, base unit mistakes, and concurrent procedure issues.
Billing ErrorsHow to Fight Duplicate Charges on Your Medical Bill
Duplicate charges are one of the most common medical billing errors. Learn how to identify and dispute duplicate charges to save $200-$5,000.
Billing ErrorsUnderstanding Unbundling Violations on Medical Bills
Unbundling is a billing fraud where grouped procedures are billed separately to inflate costs. Learn to identify NCCI edit violations and save money.