SpecialtiesSurgical
How we see thoracic surgery billing.
Reviewed by the VisMed surgical billing team
Cardiothoracic cases carry ninety-day global periods and patients who spend days in intensive care. Most post-operative care is inside the global and not separately billable. Some is: critical care for problems unrelated to the surgery, unrelated procedures, and care after complications that return the patient to the operating room. The line between related and unrelated has to be drawn per encounter, from the documentation, and payers challenge it.
The operations themselves involve co-surgeons, assistants, and add-ons for grafts, valves and combined procedures that follow bundling rules. Video-assisted and robotic approaches have their own codes and conversion rules.
For cardiothoracic groups, VisMed opens a case per operation that tracks the global and tags every encounter, builds claims from the operative report with a second review, and gives the ICU team templates that make critical care inside the global billable and defensible.
Where thoracic surgery practices lose money
The patterns we find in the aging and denial history before anything else changes.
Critical care inside the global
Critical care unrelated to the surgery is billable during the global with modifier 24 and documentation of why. Without the process and the note, it is given away or denied.Co-surgeon and assistant claims
Combined procedures often involve two surgeons or a first assistant, with modifier 62 or assistant modifiers applied per payer rules. Mismatches deny one side.Add-ons and combined procedures
Grafts, valve add-ons and concurrent procedures are separate lines with bundling rules. Missed add-ons on high-value cases are a large leak.Returns to the operating room
Complication returns take modifier 78 and pay the intra-operative portion; staged procedures take 58. Wrong modifiers deny or reduce.Decision visits and consultations
The decision-for-surgery visit is lost without modifier 57, and inpatient consultations are billed under different rules per payer.
What we do differently for thoracic surgery
Specialty-matched coders and a denials specialist, working inside your own system.
We tag every encounter in the case
Each operation opens a case with its global; every subsequent encounter is tagged as related, unrelated or a return, and billed or held accordingly.We code from the report with a second review
Add-ons, co-surgeon and assistant lines and modifiers are built from the report and reviewed before submission.We document critical care to defend it
Templates that record time and the unrelated problem, so critical care inside the global is billable and defensible.We reconcile the census daily
Daily inpatient census matched to claims across facilities.
What we bill
The procedure and code families your account team already works in.
Thoracic surgery billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
What can we bill during the ninety-day global?
Care unrelated to the surgery, including critical care for unrelated problems, unrelated procedures, and returns to the operating room for complications. Each needs the right modifier and documentation that shows why it is separate. VisMed tags every encounter in the case so the decision is made deliberately and defended.
How does VisMed handle co-surgeon cases?
By building both claims together with modifier 62 and matching documentation, and coordinating with the other surgeon’s office when they bill elsewhere.
Does VisMed capture add-ons on combined procedures?
Yes. Grafts, valve add-ons and concurrent procedures are coded from the operative report by a cardiothoracic-trained VisMed coder and checked by a second before the claim leaves.
How does VisMed support critical care billing in the ICU?
With templates that capture time and the unrelated condition, a daily census reconciliation, and coders who apply the global-period rules per encounter.
How does VisMed bill video-assisted and robotic cases?
From the approach actually used, with the conversion rules applied when a thoracoscopic case became open. VisMed codes the case as performed rather than as scheduled, because payers compare the claim with the report.
Also in surgical
General surgery
Global-period tracking and assistant-at-surgery claims.
Orthopedics
Fracture care, implants and DME.
Neurosurgery
Multi-level procedures and co-surgeon billing.
Vascular surgery
Office-based labs and imaging supervision.
Plastic surgery
Reconstructive vs cosmetic separation.
Oral & maxillofacial surgery
Medical and dental claims on one case.
ENT
In-office procedures, audiology and allergy.
Ophthalmology
Eye-code vs E/M choice, injections and ASC.
Urology
Lithotripsy, in-office procedures and pathology.
OB/GYN
Global obstetric packages and gyn procedures.
Ambulatory surgery centers
Facility claims, implants and payer-specific groupers.
Anesthesia
Time units, modifiers and medical direction.
All specialties
The full list, in six groups
See where your thoracic surgery practice is losing money. Free.
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