Defensible Healthcare Billing: Surgery Services by Linda Myrick CPC, CPC-I is a comprehensive, audit-informed guide to constructing, evaluating, and defending surgical claims in today's data-driven reimbursement environment. Part of the Defensible Healthcare Billing series, this volume examines surgical billing not as isolated code selection, but as a structured clinical and financial event that must withstand layered review, comparative analytics, and retrospective scrutiny.
Surgical services are uniquely vulnerable to audit due to their defined procedural intensity, global payment structures, modifier usage, assistant involvement, and high reimbursement variability. This book explains how payers interpret surgical claims under automated edits, peer benchmarking, medical review, and extrapolated audit models. It emphasizes that reimbursement sustainability depends on visible medical necessity, operative detail proportionate to reported intensity, disciplined modifier logic, and alignment between diagnosis, intraoperative work, and postoperative management.
Rather than relying on proprietary code instruction, the text uses a code-agnostic framework to clarify how documentation functions as a condition of payment. It explores preoperative justification as the compliance anchor, the operative report as primary evidentiary support, intraoperative complexity validation, global period boundaries, assistant and multi-provider risk, payment reduction hierarchy, professional-facility alignment, and structured appeal strategy.
Chapters address common denial rationales, downcoding patterns, modifier escalation triggers, increased service scrutiny, bundled edit overrides, assistant surgeon utilization risk, and pattern-based audit exposure. The book also provides practical guidance for audit packaging, recoupment mitigation, extrapolation response, preventive compliance programs, and long-term surgical revenue integrity governance.
Designed for coders, auditors, surgeons, compliance leaders, revenue integrity professionals, and healthcare executives, this resource bridges the gap between technical billing knowledge and real-world audit interpretation. It equips professionals to move beyond transactional reporting and toward structurally coherent, defensible surgical billing practices.
Defensible Healthcare Billing: Surgery Services supports organizations seeking compliance stability, financial sustainability, and disciplined documentation in 2026 and beyond.
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