Surgical Oncology Billing Services

Surgical oncology billing supports surgeons who treat cancer with operations, often as part of a team with medical and radiation oncologists. Cases can be large and complex, such as pancreas, liver, or bowel resections, or more focused, such as breast conserving surgery with lymph node mapping.

Accuracy depends on the diagnosis, the staging, and the exact operation. Several procedures may happen in one session, and each may be paid at a different rate. Most major cancer operations carry a 90-day global period. A surgical oncology billing company needs to coordinate authorization, co-surgeon claims, and pathology findings, while keeping the diagnosis codes consistent across every claim for the same patient.

Who this is for

• Surgical oncologists at cancer centers and private groups
• Breast, melanoma, sarcoma, and GI cancer surgeons
• Surgeons who work with multidisciplinary tumor boards
• Groups that perform complex liver and pancreas surgery
• Practices that treat patients across several hospitals

What gets billed

• Partial and total mastectomy
• Sentinel lymph node mapping and biopsy
• Axillary and other lymph node dissection
• Pancreas and liver resections
• Colon and stomach cancer resections
• Skin cancer excisions and melanoma surgery
• Sarcoma excision
• Port placement for chemotherapy
• Pre-operative consults and tumor board participation
• Post-operative visits within the global period

Commonly billed codes

Code	Type	What it covers
19301	CPT	Partial mastectomy
19303	CPT	Complete mastectomy, simple
19307	CPT	Modified radical mastectomy
38525	CPT	Open biopsy or removal of deep lymph nodes in the armpit
38900	CPT	Add-on for identifying sentinel nodes during surgery
38792	CPT	Injection of tracer to find sentinel lymph nodes
38745	CPT	Complete removal of armpit lymph nodes
48150	CPT	Whipple-type operation on the pancreas with a pancreas to small bowel connection
47120	CPT	Partial liver removal
44140	CPT	Partial colon removal with reconnection
C50.911	ICD-10-CM	Cancer of the right female breast, site not specified
C25.0	ICD-10-CM	Cancer of the head of the pancreas
C18.7	ICD-10-CM	Cancer of the sigmoid colon

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in surgical oncology

Matching procedures to the operative note. Cancer surgery often includes several steps, such as a resection, a lymph node dissection, and a reconstruction. A biller experienced in surgical oncology reads the note and bills each separately reportable step.

Sentinel node coding. Tracer injection, mapping, and node removal use different codes, and payers differ on what is allowed together. Billers check bundling edits and who performed each step, since a nuclear medicine team may bill the injection.

Co-surgeons and assistants. Complex cases may involve a second surgeon, such as for reconstruction. Billers confirm modifier 62, 80, or 82 is allowed by the payer and that each surgeon documents their role.

Global periods. Major resections carry 90-day globals, so post-operative care is bundled. Billers track dates and use modifier 57 for the decision-for-surgery visit and 79 for an unrelated procedure.

Diagnosis consistency. Cancer diagnosis codes should match across the surgeon, pathology, and facility claims. Billers update codes when pathology confirms a diagnosis and watch for sequencing errors.

Prior authorization and second opinions. Many payers require approval for elective cancer surgery, and urgent cases may follow different steps. Billers confirm requirements early and document urgency.

Tumor board and care coordination. Payers vary on paying for tumor board time. Billers check policy rather than assume a separate code is allowed.

How Westmont can help

• Matches your group with vetted medical billing experts who work with surgical oncologists
• Connects you with end-to-end revenue cycle support for complex surgical cases
• Helps you find denial management support for bundling and authorization denials
• Connects you with credentialing support for surgeons and cancer center sites
• Offers a path to request a quote based on your case volume

Frequently asked questions

How is sentinel lymph node biopsy billed?

Billing usually involves separate pieces: the tracer injection, the intraoperative identification of the node, and the node removal. Each has its own code, and payers have rules on combinations. Different providers may perform different steps. A surgical oncology billing company checks who did what and which edits apply.

What global period applies to cancer surgery?

Most major cancer operations carry a 90-day global period under Medicare rules, while smaller procedures may carry 0 or 10 days. Related post-operative care is bundled. Check the current indicator for each code and any differences in your payers' contracts.

Can two surgeons bill for the same cancer operation?

Yes, in some cases. When two surgeons each perform a distinct part of one procedure, modifier 62 may apply if the code and payer allow it. Each surgeon must document their role. If one assists, modifier 80 or 82 may apply instead, depending on payer policy.

Why do cancer surgery claims get denied for authorization?

Many payers require approval before elective surgery, and missing or expired authorizations are a common cause of denials. Changes to the planned operation can also require an update. Billers track authorizations and confirm they match the final procedure code.

Do diagnosis codes need to change after pathology?

Often, yes. A claim may start with a suspected diagnosis, then be updated when pathology confirms cancer type and site. Billers follow payer rules for updating codes and make sure the surgeon, pathology, and facility claims agree.

Related billing services

• General Surgery
• Medical Oncology
• Radiation Oncology
• Gynecologic Oncology
• Plastic & Reconstructive Surgery
• Pathology