Best cardiothoracic RCM Service

Cardiothoracic surgery billing services

Revenue cycle management for heart and chest surgeons, from the first authorization check to the last payment posted. Our coders read the operative note before a charge is built, and each patient's 90-day global period is tracked on a calendar.

Talk to our billing team See what we handle

Operative note coding Global period tracking Payer follow-up

Coding from the operative note

One operative note can carry a dozen billing decisions.

Graft counts, conduit sources, approach changes and co-surgeon roles all sit in the surgeon's dictation. Our coders pull each one into the claim before it goes out.

Practice overview

Billing built around what happens in the operating room.

A cardiothoracic claim depends on the procedure performed, the approach used, who was in the room, where the case took place, and which payer owns the bill. A change in any one of these changes the codes.

How cardiothoracic billing works

Cardiothoracic billing covers operations on the heart, great vessels, lungs, esophagus, pleura and mediastinum. The work starts weeks before the case, with insurance verification, referral checks and prior authorization for elective operations such as valve repair or lobectomy.

After surgery, the operative report drives the coding. Diagnosis codes, CPT codes and modifiers come from that document, and the claim then moves through the clearinghouse, payer review, payment posting and A/R follow-up. For most major procedures, global period rules stay active for 90 days afterward.

What we handle

Services included in our surgical billing

Each stage is completed in order, so a problem at the front end gets fixed before a claim exists.

Insurance intake

Patient and payer details are checked against the referral and scheduling record before the case date.

Eligibility checks

Active coverage, network status, deductibles and surgical benefits are confirmed ahead of the operation.

Prior authorization

Requests go to the payer with the surgeon's notes, imaging and test results attached.

Operative report review

Coders read the dictation for the primary procedure, add-on procedures, approach and any complications.

Coding and modifiers

ICD-10-CM and CPT codes are assigned, and modifiers such as 62, 78 or 80 are applied only where the record supports them.

Global period tracking

Each surgery date opens a 90-day window, and follow-up visits are sorted into included or billable.

Claim submission

Clean claims go out electronically, and clearinghouse rejections are worked as soon as they post.

Denial management

Denial reasons are traced to the source, corrected, and appealed with the operative note and payer policy.

Posting and A/R

ERAs are posted, payments are checked against contract rates for underpayments, and aging claims are followed up by payer.

Procedure coverage

How billing differs across cardiac and thoracic procedures

Documentation requirements change from one operation to the next. These are the categories our coders work with most.

Coronary bypass

CABG graft counting and conduit source

The claim depends on how many grafts were placed and whether each used vein, artery or both. Endoscopic vein harvest and reoperation add-ons carry their own codes.

Valve surgery

Repair, replacement and redo operations

Aortic, mitral and tricuspid cases are coded by valve and by whether the surgeon repaired or replaced it. Redo sternotomies are checked for modifier support before submission.

Transcatheter valves

TAVR and two-physician reporting

Transcatheter aortic valve cases involve a cardiac surgeon and an interventional cardiologist, and each reports the procedure with modifier 62. Both notes have to describe the same operation.

Aortic surgery

Ascending, arch and descending repairs

Coding follows the aortic segment treated, the graft used, and whether circulatory arrest or bypass was required. Combined root and valve work is checked against code descriptors before anything is added.

Thoracic surgery

Lobectomy, pleural and esophageal cases

Open and thoracoscopic lobectomy sit under different codes, and lymph node dissection may add a separate line. Chest wall, mediastinal and esophageal cases follow their own code sets.

Minimally invasive

Thoracoscopic, robotic and converted cases

Coders look for a clear statement of approach in the note. When a thoracoscopic case turns into an open one, CPT guidance points to the open code, and the attempted approach is not billed on top.

Coding and documentation

The operative report decides how the claim reads.

The surgeon's dictation is the main source document. Coders pull the pre and post-operative diagnoses, the procedures performed, the grafts and implants used, and the role of each provider in the room.

Diagnosis codes show why the surgery was needed. CPT codes show what was done. Modifiers explain the unusual parts: a second surgeon, an assistant, a staged procedure, or a return to the operating room.

Codes then run through National Correct Coding Initiative edits before submission. When a dictation is vague or leaves out a graft, the coder sends a query to the surgeon instead of guessing.

Global surgery period

Follow-up care needs its own tracking after the operation.

Most major heart and chest operations carry a 90-day global period, and under Medicare rules it also covers the day before surgery. Every visit inside that window needs a decision: included in the package or separately billable.

Care inside the package

Routine post-operative visits, dressing changes and chest tube removal are bundled into the surgical fee. These are not billed separately.

Care billed on its own

A visit for a condition unrelated to the surgery, or a return to the operating room for a complication, can be billable with a modifier such as 24, 78 or 79. The note has to show why.

Before the case

Authorization work starts well before the scheduled date.

Confirm active coverage and whether the surgeon and hospital are in network.
Check whether the plan requires a referral from cardiology or primary care.
Look up authorization rules for the specific CPT codes planned.
Send the H&P, imaging and test results the payer asks for.
Log the authorization number and approved units in the billing record.

Two claims, one operation

Surgeon fees and hospital charges follow separate paths.

A single bypass or lobectomy can produce a professional claim and a facility claim. Mixing the two causes rejections and misapplied payments.

Professional billing

Billed on the CMS-1500 form, this claim reports the surgeon's own work, with CPT codes, modifiers and place of service.

Facility billing

The hospital bills its operating room, implants, supplies and nursing time on a UB-04. Employed surgeons may be billed through the hospital's system instead of a separate group.

Our process

How a cardiothoracic claim moves through our team

Five stages, each with a defined handoff, from pre-surgery checks to reconciliation.

Step 01

Verify

Insurance, benefits and authorization are checked before the operation.

Step 02

Code

Coders read the operative report, query the surgeon on gaps, and assign codes and modifiers.

Step 03

Submit

Claims go through the clearinghouse, and rejections are corrected and resent.

Step 04

Resolve

Denials are researched by cause, appealed with records, and tracked to a decision.

Step 05

Reconcile

Payments are posted against contract rates, underpayments are flagged, and balances are matched to deposits.

Frequent problem areas

Where cardiothoracic claims tend to go wrong.

Denials in this specialty usually trace back to a short list of recurring problems in the record or the payer rules.

Dense operative notes

One case can include grafting, valve work and a cannulation change, each needing its own coding decision.

Modifier conflicts

Assistant, co-surgeon and return-to-OR modifiers trigger denials when the notes do not match the claim.

Global period errors

Visits billed inside the 90-day window without an unrelated diagnosis get denied or recouped.

Missing authorization

Elective cases without an approval on file may be denied, sometimes after payment.

Medical necessity

Payers read the diagnosis and history to decide whether the operation was warranted.

Claim mismatches

Professional and facility claims need matching dates, providers and places of service.

Coding audits

Periodic reviews that compare the chart with the claim.

Sampled cases are checked line by line, so patterns show up before a payer finds them.

Note against claim

Every billed line is matched to something the surgeon documented.

Diagnosis review

Codes are checked for specificity and support in the history.

Modifier use

Modifiers are tested against the record and the payer's policy.

Bundling edits

NCCI pairs and global rules are rechecked for missed or improper lines.

Michigan practices

Cardiothoracic surgery billing in Michigan

Cardiothoracic groups in Houston, Dallas-Fort Worth, San Antonio and Austin bill a wide mix of payers. That mix includes Medicare through Novitas Solutions, Michigan Medicaid and its managed care plans, Blue Cross and Blue Shield of Michigan, national carriers, and a large number of Medicare Advantage plans.

State rules add another layer. Fully insured plans fall under prompt-pay law and Department of Insurance mediation for out-of-network disputes, while self-funded employer plans follow federal rules and the No Surprises Act dispute process. Our team sorts each claim by plan type before working it.

FAQs

Cardiothoracic surgery billing questions

What is the function of a billing service for cardiothoracic surgery?

Authorization, operative report coding, claims, payment posting, rejection appeals, and A/R follow-up are among the administrative aspects of heart, lung, and chest surgery that it manages. Surgeons avoid dealing with payer paperwork.

What distinguishes it from standard medical billing?

Long operating notes with many operations, modifiers, assistant surgeon guidelines, and a 90-day worldwide period are the source of claims. All of it is absent from a typical office visit claim.

Which processes require this degree of specificity?

Whether performed open, thoracoscopically, or robotically, CABG, aortic, mitral, and tricuspid valve surgery, TAVR, aortic aneurysm repair, lobectomy, and esophageal surgery all require meticulous coding.

How is CABG billed?

The count and type of grafts decide the codes. Arterial and venous grafts are coded separately, and vein harvest or reoperation add-ons may apply when the note supports them.

How does the global period affect billing?

Routine follow-up is bundled into the surgical fee for the length of the period, usually 90 days for major procedures. Unrelated visits or returns to the OR may be billed with modifiers.

How are assistant and co-surgeon roles billed?

Each provider's role is confirmed from the note. Assistants use modifiers 80, 82 or AS, and co-surgeons use 62, but payers decide which codes allow either.

Why do these claims get denied?

Common causes are missing notes, mismatched diagnosis and procedure codes, modifier errors, visits billed inside the global window, missing authorization, bundling edits and late filing.

What is the difference between professional and facility billing?

Professional claims pay for the surgeon's work. Facility claims cover the operating room, implants, supplies and nursing. They use separate forms and are adjudicated separately.

Michigan surgical RCM

Talk to our billing team

Bring questions about coding, claim submission, denials or A/R on cardiothoracic cases, and the team will walk through how the work would run for the practice.

Discuss your billing needs

Talk to our billing team

Best cardiothoracic RCM Service

Cardiothoracic surgery billing services

Talk to our billing team See what we handle

Operative note coding Global period tracking Payer follow-up

Coding from the operative note

One operative note can carry a dozen billing decisions.

Graft counts, conduit sources, approach changes and co-surgeon roles all sit in the surgeon's dictation. Our coders pull each one into the claim before it goes out.

Specialty focus Heart, lung and chest surgery

Practice overview

Billing built around what happens in the operating room.

How cardiothoracic billing works

What we handle

Services included in our surgical billing

Each stage is completed in order, so a problem at the front end gets fixed before a claim exists.

Insurance intake

Patient and payer details are checked against the referral and scheduling record before the case date.

Eligibility checks

Active coverage, network status, deductibles and surgical benefits are confirmed ahead of the operation.

Prior authorization

Requests go to the payer with the surgeon's notes, imaging and test results attached.

Operative report review

Coders read the dictation for the primary procedure, add-on procedures, approach and any complications.

Coding and modifiers

ICD-10-CM and CPT codes are assigned, and modifiers such as 62, 78 or 80 are applied only where the record supports them.

Global period tracking

Each surgery date opens a 90-day window, and follow-up visits are sorted into included or billable.

Claim submission

Clean claims go out electronically, and clearinghouse rejections are worked as soon as they post.

Denial management

Denial reasons are traced to the source, corrected, and appealed with the operative note and payer policy.

Posting and A/R

ERAs are posted, payments are checked against contract rates for underpayments, and aging claims are followed up by payer.

Procedure coverage

How billing differs across cardiac and thoracic procedures

Documentation requirements change from one operation to the next. These are the categories our coders work with most.

Coronary bypass

CABG graft counting and conduit source

The claim depends on how many grafts were placed and whether each used vein, artery or both. Endoscopic vein harvest and reoperation add-ons carry their own codes.

Valve surgery

Repair, replacement and redo operations

Aortic, mitral and tricuspid cases are coded by valve and by whether the surgeon repaired or replaced it. Redo sternotomies are checked for modifier support before submission.

Transcatheter valves

TAVR and two-physician reporting

Transcatheter aortic valve cases involve a cardiac surgeon and an interventional cardiologist, and each reports the procedure with modifier 62. Both notes have to describe the same operation.

Aortic surgery

Ascending, arch and descending repairs

Thoracic surgery

Lobectomy, pleural and esophageal cases

Open and thoracoscopic lobectomy sit under different codes, and lymph node dissection may add a separate line. Chest wall, mediastinal and esophageal cases follow their own code sets.

Minimally invasive

Thoracoscopic, robotic and converted cases

Coders look for a clear statement of approach in the note. When a thoracoscopic case turns into an open one, CPT guidance points to the open code, and the attempted approach is not billed on top.

Coding and documentation

The operative report decides how the claim reads.

Codes then run through National Correct Coding Initiative edits before submission. When a dictation is vague or leaves out a graft, the coder sends a query to the surgeon instead of guessing.

Global surgery period

Follow-up care needs its own tracking after the operation.

Care inside the package

Routine post-operative visits, dressing changes and chest tube removal are bundled into the surgical fee. These are not billed separately.

Care billed on its own

A visit for a condition unrelated to the surgery, or a return to the operating room for a complication, can be billable with a modifier such as 24, 78 or 79. The note has to show why.

Before the case

Authorization work starts well before the scheduled date.

Confirm active coverage and whether the surgeon and hospital are in network.
Check whether the plan requires a referral from cardiology or primary care.
Look up authorization rules for the specific CPT codes planned.
Send the H&P, imaging and test results the payer asks for.
Log the authorization number and approved units in the billing record.

Two claims, one operation

Surgeon fees and hospital charges follow separate paths.

A single bypass or lobectomy can produce a professional claim and a facility claim. Mixing the two causes rejections and misapplied payments.

Professional billing

Billed on the CMS-1500 form, this claim reports the surgeon's own work, with CPT codes, modifiers and place of service.

Facility billing

The hospital bills its operating room, implants, supplies and nursing time on a UB-04. Employed surgeons may be billed through the hospital's system instead of a separate group.

Our process

How a cardiothoracic claim moves through our team

Five stages, each with a defined handoff, from pre-surgery checks to reconciliation.

Step 01

Verify

Insurance, benefits and authorization are checked before the operation.

Step 02

Code

Coders read the operative report, query the surgeon on gaps, and assign codes and modifiers.

Step 03

Submit

Claims go through the clearinghouse, and rejections are corrected and resent.

Step 04

Resolve

Denials are researched by cause, appealed with records, and tracked to a decision.

Step 05

Reconcile

Payments are posted against contract rates, underpayments are flagged, and balances are matched to deposits.

Frequent problem areas

Where cardiothoracic claims tend to go wrong.

Denials in this specialty usually trace back to a short list of recurring problems in the record or the payer rules.

Dense operative notes

One case can include grafting, valve work and a cannulation change, each needing its own coding decision.

Modifier conflicts

Assistant, co-surgeon and return-to-OR modifiers trigger denials when the notes do not match the claim.

Global period errors

Visits billed inside the 90-day window without an unrelated diagnosis get denied or recouped.

Missing authorization

Elective cases without an approval on file may be denied, sometimes after payment.

Medical necessity

Payers read the diagnosis and history to decide whether the operation was warranted.

Claim mismatches

Professional and facility claims need matching dates, providers and places of service.

Coding audits

Periodic reviews that compare the chart with the claim.

Sampled cases are checked line by line, so patterns show up before a payer finds them.

Note against claim

Every billed line is matched to something the surgeon documented.

Diagnosis review

Codes are checked for specificity and support in the history.

Modifier use

Modifiers are tested against the record and the payer's policy.

Bundling edits

NCCI pairs and global rules are rechecked for missed or improper lines.

Michigan practices

Cardiothoracic surgery billing in Michigan

FAQs

Cardiothoracic surgery billing questions

What is the function of a billing service for cardiothoracic surgery?

What distinguishes it from standard medical billing?

Long operating notes with many operations, modifiers, assistant surgeon guidelines, and a 90-day worldwide period are the source of claims. All of it is absent from a typical office visit claim.

Which processes require this degree of specificity?

How is CABG billed?

The count and type of grafts decide the codes. Arterial and venous grafts are coded separately, and vein harvest or reoperation add-ons may apply when the note supports them.

How does the global period affect billing?

Routine follow-up is bundled into the surgical fee for the length of the period, usually 90 days for major procedures. Unrelated visits or returns to the OR may be billed with modifiers.

How are assistant and co-surgeon roles billed?

Each provider's role is confirmed from the note. Assistants use modifiers 80, 82 or AS, and co-surgeons use 62, but payers decide which codes allow either.

Why do these claims get denied?

Common causes are missing notes, mismatched diagnosis and procedure codes, modifier errors, visits billed inside the global window, missing authorization, bundling edits and late filing.

What is the difference between professional and facility billing?

Professional claims pay for the surgeon's work. Facility claims cover the operating room, implants, supplies and nursing. They use separate forms and are adjudicated separately.

Michigan surgical RCM

Talk to our billing team

Bring questions about coding, claim submission, denials or A/R on cardiothoracic cases, and the team will walk through how the work would run for the practice.

Discuss your billing needs