Outsourcing to MBC:
MBC’s medical billing and coding services cover the entire range of insurance-claim-related requirements for plastic surgery, starting from eligibility verification of the patient to claim submission and post submission follow-ups.
Plastic surgery practices lose significant revenue through misclassified reconstructive claims denied as cosmetic, undercoded tissue flap and wound repair complexity, and multi-procedure operative sessions reduced by incorrect modifier application that payers exploit without pushback.
MBC's Revenue Diagnostic evaluates your plastic surgery billing at the procedure, payer, and operative session level — identifying where reconstructive complexity is being downcoded, which skin substitute and post-mastectomy reconstruction claims are failing adjudication and why, and how your AR aging compares against specialty benchmarks. The output is a clear, actionable breakdown of the revenue your practice is currently leaving uncollected.
With years of experience in dealing with plastic surgery cases in particular and insurance claim preparation and submission in general, our medical billers and coders understand the nature of your organization, its size and scale and bring to you an approach that’s customized to your specific needs.
It helps you meet your administrative and technical responsibilities involved in claim preparation and submission and improve your finances.
MBC delivers this both through a consulting model where it helps you to streamline your revenue management cycle by recommending appropriate software applications, helping plug sources of revenue leakages and trainings where required, and also outsource your entire billing and coding responsibilities to MBC.
Plastic surgery billing operates at one of the most complex reimbursement boundaries in healthcare — where revenue depends on the precise segregation of reconstructive and cosmetic services, accurate documentation of medical necessity for insurance-covered procedures, and the correct application of modifiers across multi-procedure operative sessions that payers challenge routinely.
MBC acts as your Revenue Integrity Partner by ensuring that every plastic surgery encounter is coded to its highest defensible specificity, reconstructive vs. cosmetic service boundaries are correctly maintained at the claim level, and payer policies around skin substitute applications, tissue flap complexity, and post-mastectomy reconstruction sequencing are executed with precision — so your practice retains every dollar it clinically justifies.
Some of the popular procedures that our billers and coders recommend could be problem areas in your revenue leakage:
Breast Reconstruction :
Although a type of plastic surgery, it is for the most part a complex reconstructive or health-related procedure, where, if the attendant health risks are not adequately addressed, the patient would go through long suffering and be faced with serious health hazards.
This being the nature of the surgery, it often presents the physician with the challenge of separating the parts of the procedure that are covered by Medicaid and the parts that aren’t. Our medical billers are coders are adept in handling these complexities and helping you prepare an air-tight claim with minimal chances of denial.
Palatoplasty :
A surgery to repair cleft palate, this procedure involves parts that are not purely cosmetic but reconstructive presenting the challenge to physicians or clinicians to identify such parts of the procedure as would be eligible for insurance reimbursement.
Our medical billers are coders are skilled in helping you conclusively separate the parts of the procedure that have reconstructive character and therefore insurance eligibility from parts that don’t.
Blepharoplasty :
A procedure to correct hooded eyelids, even though it’s cosmetic in nature, it is a surgical correction of a defect with the potential to damage a body part – the eye – and therefore reconstructive in parts at least.
We help you identify the reconstructive areas of the procedure to ensure you are reimbursed for them.
Rhinoplasty (nose job):
It involves correction of a part of the nose that, if not properly aligned, can affect the functioning of the nose. However, as Rhinoplasty is broadly cosmetic in nature, physicians often overlook this reconstructive element which is eligible for reimbursement.
MBC’s billing and coding professionals have helped health care providers involved in plastic surgery bring down their insurance denial rates substantially leading to timely payment of their services and optimal use of their staff either by helping them to focus solely on healthcare or by providing consultancy services so that they handle their revenue management responsibilities more effectively with the help of appropriate software applications and smoother and easy-to-follow processes.
MBC will help you perform the perfect plastic surgery by taking over what MBC does best so that you have to only do what you do best – surgery.
Plastic surgery is a procedure-intensive, documentation-driven specialty where revenue leakage accumulates through reconstructive-cosmetic misclassification, missed add-on codes across complex wound repair and flap procedures, and medical necessity documentation gaps that give payers grounds for denial without internal detection.
MBC helps plastic surgery practices Yield your EBITDA by maximizing reimbursement on high-complexity reconstructive procedures and multi-stage operative sessions, reducing denials on tissue flap, skin substitute, and post-mastectomy reconstruction claims, and ensuring that every billable service performed — from complex wound closures to microsurgical reconstructions — is captured, coded, and collected in full. The result is a billing operation that turns your surgical complexity directly into sustainable financial performance.
