Home Specialities General Surgery
High-acuity surgery
open & laparoscopic
Surgery-certified coders
operative-note review
All major payers
commercial, Medicare & MA
Underpayment recovery
on claims marked paid
The 90-day window is where your surgical revenue quietly disappears.
Ask a surgical practice about revenue-cycle pain and you'll hear prior auth, infection documentation, and A/R days. Real problems — the loud ones. Not the most expensive. The most expensive one clears cleanly and posts as paid: an assistant's line zeroed, an unrelated post-op visit denied, an hour of extra dissection reimbursed at the routine rate.
Across the 29 general surgery revenue cycles we've analyzed, an average of 4.3–7.2% of gross revenue is withheld this way. On a $12M practice, that's $516K–$864K a year — and it compounds over every payer-contract cycle.
See what got swept inWhat 4.3–7.2% looks like on a $12M practice
The 4.3–7.2% range reflects OneMed's analysis of 29 general surgery revenue cycles; the dollar figures apply that range to a $12M example practice. Your actual exposure depends on payer mix, case mix, and documentation.
The global period bundles routine care — not everything.
Plenty of what happens around a surgery is legitimately separate and separately payable — if the right modifier is attached. Drop it, and the payer keeps it inside the package at $0. Here's what should break out.
| Around the surgery | Payer's default | Breaks out with | If the modifier's dropped |
|---|---|---|---|
| Office visit where surgery is decided | "Pre-op, included" | Modifier 57 | E/M paid $0 |
| Assistant surgeon's work | "Not authorized" | Mod 80 / 82 / AS | Assistant paid $0 |
| Extra dissection / open conversion | "Included in procedure" | Modifier 22 | Extra work unpaid |
| Unrelated visit, day 21 post-op | "Post-op care" | Modifier 24 | Visit denied |
| Return to OR for a complication | "Post-op care" | Modifier 78 | Return paid $0 |
Illustrative of how global-period rules are commonly misapplied; modifier applicability depends on the specific encounter, documentation, and payer policy.
Five ways surgical work gets kept inside the package.
General surgery billing is a maze of global periods, assistant rules, and documentation links. These are the underpayment patterns we find most often, on claims that already say "paid."
Global-period modifier erasure (24/58/78/79)
General surgery carries 0-, 10-, and 90-day global periods. A return within that window can be unrelated (Modifier 24), a staged or related procedure (58), a complication requiring a return to the OR (78), or an unrelated procedure (79) — all separately payable. Payers see a code inside the global window and pay $0 with "included in global surgical package."
Assistant surgeon zeroed (80/82/AS)
Complex cases need an assistant; the assistant's work bills with Modifier 80, 82, or AS and pays a set percentage of the surgeon's fee. Payers zero it — "assistant not authorized" or "not medically necessary" — even when it's documented and appropriate.
Decision-for-surgery downgrade (Modifier 57)
When the decision for major surgery is made at an office visit, Modifier 57 makes that E/M separately payable even though it falls in the global period. Payers bundle it as "pre-operative work" when the note doesn't explicitly document the decision.
Increased work & open conversion (Modifier 22)
Dense adhesions, an extra hour of dissection, a laparoscopic case converted to open — this extra work is reported with Modifier 22 or the appropriate codes. Payers deny Mod 22 outright or grant a token increase, and pay open conversions at the laparoscopic rate.
Complex-patient E/M downgrade
Surgical patients carry heavy comorbidities and extensive workup that justify high-level E/M (99214/99215, 99204/99205). Payers apply blanket downgrades to 99213/99203, ignoring the real complexity.
The assistant's share is a real number. Watch it pay zero.
When an assistant surgeon is medically necessary and documented, Medicare reimburses the assistant at roughly 16% of the surgeon's fee schedule, billed with Modifier 80, 82, or AS. That's a defined, separately-payable amount.
Payers zero it — "assistant not authorized" — even when it's appropriate and documented. The rule is public; you can check the assistant lines on your own remits.
See it on your own claimsThe assistant's 16%, paid at 0%
Medicare reimburses an assistant at surgery at roughly 16% of the surgeon's fee schedule; the $2,000 is illustrative and commercial rates vary — confirm your contracts. Assistant eligibility depends on the procedure.
Bandwidth, not effort
Your billing team isn't failing — they're buried in surgical scheduling and prior-auth battles while the back-end payments go unaudited.
The "paid means paid" blind spot
Your team chases $0 rejections; a claim marked paid closes the file — even if the assistant's line or an unrelated post-op visit was zeroed inside it.
No global-period tracking
When a patient returns weeks post-op, nobody's flagging whether it's related or unrelated — so the Modifier 24/58/78/79 opportunity is never captured, and the visit pays $0.
No assistant-surgeon verification
Most practices submit the assistant claim, see "paid," and never check whether the assistant's portion was silently reduced to zero.
We pull your separate work back out of the package.
Seamless workflow integration plus general-surgery-certified coders. We work inside your existing practice-management system — no EHR change, no disruption — and counter rigid payer rules with people who read the operative note.
ClearView operational visibility
Our ClearView dashboard flags when a cholecystectomy with extensive adhesiolysis paid like a routine one, an assistant line was zeroed, or a post-op E/M was erased — without changing how your staff logs in.
Expert clinical chart audit
Flagged claims route to our general-surgery-certified coders, who work inside your system to read the operative report, verify the procedures and assistant documentation, and check whether a global-period encounter qualifies for Modifier 24/58/78/79.
Targeted clinical appeal
We draft a documentation-backed appeal — proving the unrelated visit, the complication return, the assistant's role, or the increased work.
Payer pattern mapping
We track which payers erase your Modifier 24 or deny your Mod 22, and pursue systematic corrections and contract fixes — not just one claim at a time.
The 2026 OneMed General Surgery Revenue Leak Index.
We don't rely on hypothetical math or isolated stories. We aggregated the anonymized data from every general surgery revenue cycle we audited over the last 18 months — here's the pattern it exposed.
29
surgery revenue cycles audited
142,000+
claims audited
$3.09M
recovered for clients
89.1%
recovery rate on appeals
Of that $3.09M, here's where it had been hiding. The work that should break out of the global package is exactly where the money is kept in.
| Underpayment pattern | Share of recovered value |
|---|---|
| E/M downgrades on complex surgical patients | 26% |
| Global-period modifier erasure | 23% |
| Assistant surgeon modifier traps | 21% |
| Increased-work & open-conversion bundling | 18% |
| Decision-for-surgery downgrades | 12% |
Aggregated across OneMed general surgery underpayment audits over the trailing 18 months ($3.47M identified, $3.09M recovered). Individual results vary by payer, documentation, and contract terms.