Cardiothoracic Surgery Billing Services

Cardiothoracic surgery billing is high-stakes coding. Coronary bypass, valve repair and replacement, and lung resection cases carry 90-day global periods, multi-surgeon teams, implanted devices, and intensive post-operative care, and a single case can generate professional, assistant, and co-surgeon claims that must all agree. One inconsistency between the operative report and the claim set can hold up the entire case payment.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for cardiothoracic surgery practices, built around complex cardiac and thoracic operative coding.

Cardiothoracic surgery billing challenges

The global period and the team structure interact on every major case. A 90-day global period bundles routine post-operative care into the surgical payment, so follow-up visits, wound care, and minor complications inside the window are not billed separately. Legitimate exceptions need the right modifier and documentation: an unrelated visit with modifier 24, a staged procedure with modifier 58, an unplanned return to the operating room with modifier 78, or an unrelated procedure with modifier 79.
Surgeon roles are the second challenge. Complex cardiac and thoracic cases frequently involve assistant surgeons and co-surgeons, reported with modifiers 80 and 62 respectively, and not all payers reimburse every role for every procedure. The operative report must support who did what, and the claim set must be consistent across the primary surgeon, the assistant, and the co-surgeon, or payers deny the supporting roles as duplicative.
Device and staged-work documentation is the third challenge. Valve and bypass cases involve devices, grafts, and hardware that must be documented distinctly from the professional service, and staged or related procedures during the post-operative period need modifier 58 with a clear plan documented in advance. Prior authorization for elective cardiac and thoracic procedures, and medical necessity documentation tying the diagnosis and prior treatment failures to the operation, must be complete before the case, since retrospective authorization appeals for high-value cases are rarely successful.

What MedPlus RCM handles for cardiothoracic surgery practices

  • End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
  • Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
  • Provider credentialing and enrollment. End-to-end enrollment with commercial payers, Medicare, and Medicaid, plus re-credentialing maintenance.
  • Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
  • A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
  • Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
    We serve cardiothoracic surgery practices of every size, from solo surgeons to multi-surgeon groups, across all 50 states.

Results cardiothoracic surgery practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

How are assistant and co-surgeon roles billed?
Assistant surgeons are reported with modifier 80 and co-surgeons with modifier 62, but payer coverage varies by procedure. We verify coverage before the case and bill each role only where the payer reimburses it, with operative documentation supporting who did what.
What is bundled into a 90-day global period?
Routine post-operative care, including follow-up visits, wound care, and minor complications, for 90 days after a major operation. Only distinct work with the correct modifier qualifies for separate billing.
When does a staged procedure use modifier 58?
When a related procedure during the post-operative period was planned or staged in advance, or is more extensive than the original procedure. An unplanned return to the operating room for a complication uses modifier 78 instead.
Why do cardiothoracic cases need prior authorization work before surgery?
Because elective cardiac and thoracic procedures are high value and frequently require authorization, and retrospective appeals after the case are rarely successful. We secure authorization and medical necessity documentation before the operation.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your cardiothoracic surgery practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
Request your free financial audit