Vascular Surgery Billing Services
Vascular surgery runs two global-period tracks side by side, and mixing them up is one of the most common modifier errors in the specialty. Open procedures carry the standard 90-day major surgery global period, while many endovascular add-on and second-look codes carry a 0-day global because they are built around a single encounter rather than a recovery period. On top of that, endovascular revascularization is coded by vascular territory, so a case that treats two territories is not coded like a case that treats one.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for vascular surgery practices, built around the specialty’s actual code families and payer requirements.
Vascular Surgery billing challenges
The global period track must be decided at the time the plan is made. Open procedures such as open aortic aneurysm repair, open bypass, and carotid endarterectomy carry the standard 90-day global period. Most endovascular add-on and second-look codes, by contrast, carry a 0-day global. Modifier 58 is used for a staged or related procedure during the same global period, for example a planned second-stage lower extremity revascularization treating a different territory than the first session, when the second procedure was anticipated at the time of the first and documented as such. Modifier 24 is used for an unrelated evaluation and management service during a global period, while an evaluation addressing the surgical site or a surgical complication during the same window is not separately billable. Modifier 25 applies to a significant, separately identifiable evaluation on the same day as a diagnostic vascular study or a minor procedure, never on an evaluation billed the same day as a 90-day major open procedure.
Lower extremity endovascular revascularization is organized by territory, with separate code families for the iliac, femoral and popliteal, and tibial and peroneal territories, and within each territory the code depends on whether the treatment was angioplasty alone, stent placement, atherectomy, or a combination. Treating multiple vessels or multiple territories in one session requires the correct hierarchy of primary and add-on codes, and treating the code range as interchangeable either undercodes a complex case or stacks codes the payer will bundle back down.
Endovascular aneurysm repair, or EVAR, uses its own code family (34701 through 34708), with the code selected by the anatomy treated and whether the repair was for rupture or for another indication. Stenting performed inside the treatment zone of the endograft is included in the placement work, while separate stents placed outside the treatment zone are coded separately. When EVAR is performed by cooperating physicians, each participant reports the repair codes with modifier 62 for co-surgeons or modifier 80 for an assistant surgeon, as appropriate. Dialysis access work adds another family: revision of an arteriovenous fistula without thrombectomy is reported with 36832 and with thrombectomy with 36833, while thrombectomy alone is reported with 36831 for open procedures or 36870 for percutaneous procedures, and revisions inside the original 90-day global period require the unrelated-procedure modifier.
What MedPlus RCM handles for Vascular 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 and Medicare, 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 vascular surgery practices nationwide, including hospital-based groups, office-based labs, and practices offering open surgery, endovascular intervention, and dialysis access care.
Results Vascular 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
Why do open and endovascular cases have different global periods?
Open major procedures carry a 90-day global period covering the recovery window. Many endovascular add-on and second-look codes carry a 0-day global because they describe a single encounter rather than a recovery period.
How are staged procedures billed during a global period?
A planned staged procedure during the same global period is reported with modifier 58, and the documentation must show the second stage was anticipated at the time of the first procedure.
How is lower extremity revascularization coded?
By vascular territory: iliac, femoral and popliteal, and tibial and peroneal territories each have their own code family, and within each territory the code depends on the treatment type and whether additional vessels were treated.
How are fistula revisions inside the global period billed?
A revision or thrombectomy within 90 days of fistula creation falls inside the original global period, so the unrelated-procedure modifier is required on the revision or thrombectomy code.
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 vascular surgery practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
