Cardiothoracic Surgery Billing Services

Cardiothoracic surgery billing deals with long, complex operations on the heart, lungs, and chest. A single bypass case can include several grafts, vein harvest, and add-on codes. Valve replacement, lung resection, and chest wall work each follow their own coding rules.

Many cases involve more than one surgeon. Transcatheter valve procedures, for example, are generally reported with two physicians sharing the work. That makes modifiers, payer rules, and documentation critical. Most major operations also carry a 90-day global period. A cardiothoracic surgery billing company should be able to read an operative note, count grafts, and sort out which services belong in the global package and which do not.

Who this is for

• Cardiac and thoracic surgeons in private groups and hospital employment
• Surgeons who work in structural heart programs with cardiologists
• Practices that cover lung cancer and chest surgery
• Groups that provide intensive care and call coverage after surgery
• Practices with surgical assistants and physician extenders

What gets billed

• Coronary artery bypass with vein or arterial grafts
• Aortic and mitral valve replacement or repair
• Transcatheter aortic valve replacement as part of a surgeon-and-cardiologist team
• Lobectomy and other lung resections, open or thoracoscopic
• Thoracoscopy and pleural procedures
• Chest tube placement
• Pericardial drainage
• Assistant-at-surgery services
• Pre-operative evaluation and decision-for-surgery visits
• Post-operative critical care that is not part of the global package

Commonly billed codes

Code	Type	What it covers
33533	CPT	Bypass using one arterial graft
33510	CPT	Bypass using one vein graft
33405	CPT	Aortic valve replacement with a prosthetic valve
33430	CPT	Mitral valve replacement
33361	CPT	Transcatheter aortic valve replacement through the femoral artery
32663	CPT	Thoracoscopic removal of a lung lobe
32480	CPT	Open removal of a single lung lobe
32650	CPT	Thoracoscopy with pleurodesis
33025	CPT	Opening the pericardium for drainage
I25.10	ICD-10-CM	Coronary artery disease without chest pain
I35.0	ICD-10-CM	Narrowing of the aortic valve, not caused by rheumatic disease

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 cardiothoracic surgery

Counting grafts correctly. Bypass coding depends on the number and type of grafts, and arterial and vein grafts use different codes. A biller experienced in cardiothoracic surgery compares the operative note with the charge before submission.

Co-surgeon billing. Procedures such as transcatheter valve replacement are reported with two surgeons, each using modifier 62, when payer rules call for it. Billers confirm both physicians document their part and that both claims match.

Assistant surgeon rules. Whether an assistant is payable depends on the procedure and payer. Billers check the payer's list first and then apply the right modifier.

90-day global period. Pre-operative visits the day before and the day of surgery, and routine care after, are bundled. Billers track dates so a visit that leads to surgery gets modifier 57 and unrelated care is billed correctly.

Critical care after surgery. Critical care related to the operation is generally part of the global package. Care for an unrelated problem may be separately reported with the right modifier and notes.

Staged and return procedures. A planned later procedure may need modifier 58, and an unplanned return to the operating room may need modifier 78. Billers match the modifier to the documentation.

Inpatient-only and site-of-service rules. Payers vary on which procedures require inpatient status. Billers check current policy and make sure the facility and professional claims agree.

How Westmont can help

• Matches your group with vetted medical billing experts who work with cardiothoracic surgeons
• Connects you with end-to-end revenue cycle support, including charge review for complex cases
• Helps you find denial management support for modifier, bundling, and medical necessity denials
• Connects you with credentialing support for surgeons and hospital privileges documentation
• Offers a way to get a quote based on your volume and facilities

Frequently asked questions

How is a coronary bypass billed?

Bypass claims depend on the number of grafts and whether each is a vein or an artery. Related add-on codes, such as arterial harvest, may apply. The operative note must list each graft. A cardiothoracic surgery billing company compares the note, the charge, and the facility claim so they match before submission.

What is modifier 62 and when is it used?

Modifier 62 shows that two surgeons worked together as primary surgeons on one procedure, each performing a distinct part. Some payers require it for certain procedures, such as transcatheter valve replacement. Both surgeons bill the same code with the modifier, and each needs documentation supporting their role.

Is critical care after heart surgery billed separately?

Care related to the operation is generally part of the 90-day global package. Critical care for a different problem, not caused by the surgery, may be billable with the right modifier. Payers differ, so detailed notes and a current policy review matter.

How do I bill a visit before a major operation?

A visit on the day of or the day before major surgery, when the decision to operate is made, may be reported with modifier 57. Without it, many payers treat the visit as part of the global package. The note should clearly show the decision for surgery.

Do payers require authorization for cardiothoracic procedures?

Many do, especially for elective operations and some transcatheter procedures. Requirements change by payer and plan. Billers check authorization rules before scheduling and keep a record of reference numbers to support the claim later.

Related billing services

• Vascular Surgery
• Cardiology
• Critical Care
• General Surgery
• Hospitals (Professional & Facility, UB-04)
• Anesthesiology (incl. CRNA)