Skip to content Credex Healthcare delivers thoracic surgery billing services tailored to the specific CPT code set, operative documentation standards, prior authorization requirements, and payer-specific coverage criteria governing cardiothoracic and general thoracic surgical reimbursement. Whether your practice covers pulmonary resections, pleural procedures, mediastinal surgeries, esophageal cases, or a full scope of minimally invasive and robotic thoracic surgery, we manage your complete revenue cycle so the surgical work your team performs generates the full reimbursement it has earned, on the first claim and on every claim that follows.
First-Pass Claim Acceptance Rate Across Thoracic Surgery Payers
Claim Submission Turnaround After Operative Report Sign-Off
Insurance Payers Including Medicare Advantage and Commercial Plans
Global Period Compliance Tracking on All Surgical Episode Claims
At Credex Healthcare, every thoracic surgery claim passes through a four-point pre-submission review engineered around the specific failure modes of surgical billing. We confirm that the CPT code reflects the actual operative approach documented in the operative report. We verify that the operative report contains the clinical details Medicare and commercial payers require to establish medical necessity for the procedure performed, including the preoperative diagnosis supported by the correct ICD-10 code, the intraoperative findings, and the technique.
We cross-check global period rules to ensure that post-operative visits within the 90-day surgical global period are not billed as separate E/M services unless a documented new problem justifies the modifier -24 exception. And we confirm that prior authorization is active and tied to the specific CPT code being billed for every case where the patient’s commercial or Medicaid plan requires pre-approval. These four controls are why our thoracic surgery clients do not spend their time managing denial queues.
Our thoracic surgery billing services in the USA cover the following:
We prepare and electronically submit thoracic surgery claims within 24 to 48 hours of operative report sign-off, applying verified CPT codes for the surgical approach performed, correct ICD-10 diagnosis codes, global period management, and prior authorization numbers before every transmission.
We credential and enroll thoracic surgeons with Medicare, Medicaid, and commercial payers across all active practice locations and hospital affiliations, managing re-attestation cycles and new provider additions to keep billing fully operational as your surgical program grows.
Every denied thoracic surgery claim receives a root-cause review within 24 hours. Whether the denial is a medical-necessity dispute on a pulmonary resection, a global-period conflict, an operative documentation deficiency, or a prior-authorization gap, we appeal with the clinical evidence the payer requires before the filing deadline.
Our certified surgical coders audit operative reports, anesthesia records, and post-operative notes to confirm that billed CPT codes match the documented procedure, that surgical modifiers are correctly applied, and that no separately billable service performed during the same operative session goes uncaptured.
We manage prior authorization requests for thoracic surgical procedures, including pulmonary resections, pleural procedures, and mediastinal surgeries, under commercial and Medicaid plans that require pre-approval, tracking of authorization status, and expiration dates to prevent post-operative denials of high-value surgical claims.
From surgical scheduling and pre-authorization verification through operative charge capture, payment posting, global period management, and AR recovery, we manage your complete thoracic surgery revenue cycle so every case your surgical team completes generates its full reimbursement.
We at Credex Healthcare handle thoracic surgery billing under specific national standards. Our team knows that Medicare applies procedure-specific coverage criteria and operative documentation standards for pulmonary resection claims that differ from commercial payers’ requirements.
For the MACs that process Medicare claims in different regions, we ensure that they have their own Local Coverage Determinations for thoracic procedures. For state Medicaid programs, we add prior authorization and fee schedule rules for thoracic surgical cases that vary significantly by state and managed care contract. Our billers and coders apply proprietary clinical criteria for surgical procedures, including lobectomy, segmentectomy, and pleural procedures for commercial payers. Credex Healthcare tracks thoracic surgery billing requirements across all these dimensions, so your claims are submitted correctly for every payer your patients carry, regardless of which state your surgeons operate in.
We apply CMS coverage criteria and MAC-specific documentation requirements for thoracic surgical procedures, including correct global period management, assistant surgeon billing under modifier -80 or -82, and medical-necessity documentation for pulmonary resection and pleural procedure claims.
We manage state-specific Medicaid thoracic surgery billing requirements, including prior authorization mandates for elective surgical procedures, fee schedule compliance, and managed care organization submission protocols that vary across state programs and MCO contracts.
We handle clinical prior authorization, benefit verification, operative approach code compliance, and surgical claims submission for BCBS, Cigna, Aetna, UnitedHealthcare, and regional commercial carriers, applying each payer's current coverage criteria for minimally invasive and open thoracic procedures.
We manage professional fee billing for hospital-based thoracic surgery programs and ambulatory surgical center cases, including correct facility versus professional fee separation, assistant surgeon claims submissions, and co-surgeon billing under modifier -62 when two surgeons of equal skill are required.
Credex Healthcare helps thoracic surgery billing meet all the requirements, including precise documentation of surgical techniques, accurate ICD-10-CM diagnosis coding, and adherence to 90-day global periods for major procedures. Our billers and coders manage all the key requirements, including appropriate documentation, proper use of CPT codes, and accurate application of modifiers.
Pre-authorization is mandatory for most procedures to avoid denials. Major thoracic surgeries carry a 90-day global period. Different reimbursement rates apply, requiring strict documentation of the approach. Credex Healthcare eliminates every one of the failure points before your first claim leaves the system.
We verify that every thoracic surgeon and surgical assistant is individually enrolled with the target payer under the correct group TIN, that hospital-based billing arrangements are correctly established, and that all enrollment and credentialing records are current before any claim is submitted.
Our surgical coders review every operative report to confirm that the CPT code reflects the actual approach performed, that minimally invasive and open procedure codes are applied based on operative documentation rather than the scheduled procedure, and that separately billable concurrent procedures are correctly captured.
We audit operative reports, anesthesia records, and post-operative notes for ICD-10 diagnosis specificity, procedural detail sufficient to defend the billed code under payer review, and the clinical justification required to establish medical necessity for the surgical intervention performed.
We manage authorization requests for all thoracic surgical procedures requiring pre-approval, track authorization status against operative scheduling dates, and confirm that authorization numbers are current and attached to every applicable claim before electronic transmission.
We track 90-day surgical global periods for every thoracic case, ensuring that post-operative visits are correctly managed as either included services within the global package or separately billable E&M services supported by documented new problems and the appropriate modifier exception.
AR Follow-Up
All open thoracic surgery claims are tracked through a structured AR process by payer and aging bucket, with escalation protocols for any high-value surgical claim exceeding 45 days without payment or a formal payer determination of the outstanding balance.
Thoracic surgery practices face unique billing complexities with surgical approach coding, cancer documentation, and global period management. The billing experts of Credex Healthcare enhance your income level by decreasing the chances of claim denials. Our team works to eliminate the causes of slow claim submission. We identify the reasons for your income decline and fix them immediately. We try to improve your bottom line by efficiently getting your reimbursements and helping you run your practice smoothly.
We understand the complexities your thoracic practice might face in effectively executing charge entry of several treatments acquired at the same time. To handle every claim properly, a creative lung billing solution is needed. Every charge we enter matches the services provided to the patient and their insurance reimbursement. Our team uses its knowledge, time, and effort to find common mistakes in claims. We address the gaps that could lead to claims being denied or refused. This will make it less likely that an appeal will be sent. We make sure that the providers are happy and that every payment is processed according to the payor’s rules.
We submit thoracic surgery claims with verified operative approach codes, correct surgical modifiers, ICD-10 diagnosis codes matched to operative documentation, global period compliance, and authorization numbers attached before every electronic transmission.
Our thoracic surgery coding specialists review every operative report and concurrent procedure record to ensure CPT codes reflect the actual surgical work performed and that every separately billable procedure within the operative session is captured and correctly reported.
Prior Authorization Management
We initiate and track prior authorizations for all thoracic surgical procedures requiring pre-approval, monitor authorization status against operative scheduling, and confirm that no elective surgical case proceeds without a current and procedure-specific authorization number confirmed with the payer.
Every denied thoracic surgery claim is reviewed within 24 hours, categorized by root cause, and appealed with the operative report, imaging documentation, pre-operative workup records, and clinical justification narrative that the payer requires to reverse the denial before the filing deadline.
We credential thoracic surgeons and cardiothoracic surgical teams with Medicare, Medicaid, and commercial payers across all active hospitals, surgical centers, and practice locations, managing re-credentialing cycles and new provider onboarding to ensure every surgeon bills from their first operative day.
Monthly reports cover your clean claim rate by procedure category, denial breakdown by CPT code and payer, global period billing performance, concurrent procedure capture rate, prior authorization approval metrics, AR aging, and net collections trend for complete revenue cycle visibility.
Surgical and Cardiothoracic Revenue Cycle Expertise
Provider Enrollment Coverage for All Active Thoracic Surgery Rosters
HIPAA Compliance Rate Across All Billing and Claims Operations
Dedicated Billing Support for Thoracic Surgery Practices and Programs
Customized Billing Workflows for Every Thoracic Surgery Practice Model
General Thoracic Surgeon
Reeves
“I had been billing my VATS lobectomy cases at the open thoracotomy code for nearly a year before Credex caught it. My previous biller assumed 32480 was the default and did not know that 32663 applied to the minimally invasive approach I had been using for most of my lobectomy volume. The CPT correction alone materially changed my per-case reimbursement, and the audit exposure I had been accumulating without knowing it was resolved at the same time. Credex found problems I did not know I had.”
Cardiothoracic Surgeon
Anita
“The administrative complexity was something our internal team could not handle with accuracy. Credex created a billing process that worked with our academic program’s structure. They also made sure that all visiting surgeons followed the same global-period rules. As a result, our thoracic claims rejection rate dropped from 22% to less than 5% in the first quarter. The effect on the department’s income was big.”
Multi-Surgeon Thoracic Surgery Group
Tillman
“Our in-house team wasn’t able to accurately manage billing for six thoracic surgeons across two hospital affiliations, each with their own global period tracking requirements, commercial payer authorization requirements for elective resections, and different billing arrangements for assistant surgeons. Credex was in charge of the whole income cycle for both sites. Our AR days went from 67 to 29, and the missed periods after surgery that happened every month stopped happening. The cash situation got better right away.”
Minimally Invasive Thoracic Surgeon
Elena
“My practice is almost exclusively VATS and robotic thoracic surgery, which means every claim. The billing team I worked for before didn’t read the operating notes carefully enough, so they sent in open procedure codes for VATS cases without asking why. Credex noticed the trend right away, fixed it, and filed an appeal for the back-dated claims that were not paid in full. The recovery from the appeal process alone was worth more than a year of billing fees.”
Thoracic Oncology Surgeon
Siemen
“Billing thoracic oncology surgery involves ICD-10 coding specificity for lung cancer staging and laterality that most billing companies are simply not equipped to handle. After Credex coded every case correctly based on the right anatomical precision, they matched the diagnosis codes to the surgical site documented in the operative report. This means our payer audit exposure for the lung cancer resection program is no longer in effect. That was the single biggest billing risk our practice had, and Credex closed it.”
Practice and Surgical Program Assessment
Before we send in a single claim, we look at your current CPT code distribution across all of your surgery cases, the accuracy of your operative approach coding, your global period compliance record, your rejection history by procedure type and payer, and any open audit or post-payment review exposure.
Credentialing and Payer Enrollment
We make sure that each thoracic surgeon and surgical assistant in your program has the right credentials and is signed up with each payer under the right group TIN and hospital billing arrangement. We also make sure that all active facility affiliations for assistant surgeons and co-surgeons have the same billing arrangements.
Operative Documentation and Authorization Workflow Setup
We work with your medical and office staff to set up rules for pre-submission documentation, ICD-10 diagnosis code specificity review for oncologic and structural diagnoses, a global period tracking protocol for all 90-day surgical episodes, and workflows for confirming prior authorization for elective resections and complex pleural procedures.
Clean Claim Submission
Before being sent electronically, every thoracic surgery claim is checked to make sure that the CPT codes match the operating report, that the right surgical modifiers are used, that the ICD-10 diagnosis codes are specific, that the global period is followed, and that the prior permission number is attached. Within 24 to 48 hours of signing off on the operational report, claims are sent in, and proof from the clearinghouse is tracked.
Denial Management and Appeals
Within 24 hours of receiving them, denied lung surgery claims are reviewed and put into groups. Our appeals team tells the difference between operative approach disputes, medical necessity fails, global period conflicts, prior authorization gaps, concurrent procedure bundling reductions, and payer adjudication errors. Appeals for high-value lung surgery claims must be submitted with the full report of the surgery.
Reporting & Ongoing Optimization
Your monthly performance reports show your clean claim rate by CPT procedure category, denial breakdown by root cause and payer, global period billing accuracy metrics, concurrent procedure capture rate, prior authorization approval performance, AR aging by payer and procedure type, and net collections trend.
Credex Healthcare is an expert in custom lung surgery billing services that protect your practice’s finances and free you to focus on giving great care to your patients. Our skilled staff handles all the complicated parts of bills, such as correct coding and following all the rules, so you can be sure that your practice revenue is in good hands.
We handle all the complicated billing for thoracic surgery by following tight payer rules, making sure all the necessary paperwork is in order, and complying with specific coding requirements. Our team ensures no billing mistakes occur that could cause claims to be denied, payments to be delayed, or less money to come in, all of which could hurt your practice’s ability to stay open for business. When you work with Credex Healthcare as your billing partner, we will make sure that your claims are handled quickly and properly thanks to our extensive expertise in thoracic surgery billing.
Our billing team maintains up-to-date knowledge of thoracic surgery CPT code classifications, VATS versus open procedure coding rules, global period management standards, concurrent procedure bundling policies, assistant and co-surgeon modifier requirements, and Medicare and commercial payer medical-necessity criteria for thoracic surgical cases.
You work with a named thoracic surgery billing account manager who knows your surgeons, operative case mix, facility billing arrangements, and payer contracts. When CMS updates its coverage criteria for pulmonary resection or a commercial payer revises its prior authorization requirements for VATS procedures, your account manager alerts you before it affects a claim.
Every client receives a detailed monthly report covering claim volume by procedure type, first-pass acceptance rate, denial breakdown by CPT code and payer, global period compliance metrics, concurrent procedure capture rate, AR aging, and net collections trend with plain-language commentary on what the data means for your surgical program's revenue.
All thoracic surgery billing operations at Credex Healthcare are conducted within a fully HIPAA-compliant environment, including encrypted EHR and operative record integration, secure electronic claim transmission, and audited access controls on all patient records, operative reports, and billing data.
Maximize your thoracic surgery practice revenue with specialized billing expertise in lung procedures, esophageal surgery, and minimally invasive techniques. Our trained coders know how to perform complex VATS coding, manage global periods, and handle the paperwork specific to lung cancer surgical practices.
Credex Healthcare will conduct a free review of thoracic surgery billing for eligible companies and programs. The audit looks at your global period compliance record, your concurrent procedure capture rate, your prior authorization compliance on commercial surgical cases, your denial rate by CPT code and payer, and your current AR aging profile. It also looks at how accurate your operative approach codes are for your most common procedure types.
Immunology billing is the process of getting paid for allergy and clinical immunology services, such as allergy skin tests, allergen immunotherapy, biologic drug administration, and treatment for immune weakness. In most practices, immunology billing is split into three separate areas: allergy testing, which has procedure-specific codes for each test type and needs documented test counts; allergen immunotherapy, which bills for both extract preparation and injections; and biologic drug administration, which pairs an HCPCS J-code for the drug with a drug administration CPT code.
CPT codes are used for allergy tests, treatments, and drug administration in immunology bills. CPT 95004 covers tests performed on the skin, such as stick and scratch tests, and is charged per test. CPT 95024 covers allergy tests applied to the skin with a single dose. One allergy immunotherapy shot is covered by CPT 95115, but no extract is given. It is covered by CPT 95117 for two or more doses without extract. The extract preparation codes range from 95144 to 95180 and depend on the type of extract and the number of doses prepared.
Yes, Medicare Part B, Medicaid, and private health plans all cover allergy and immunology treatments that are medically necessary. Medicare pays for allergy skin tests if the clinical documentation supports the number of tests paid, and the diagnosis supports the testing suggested. Biologic drugs used to treat allergic conditions are covered by Part B if they are injected in the office and meet certain medical-necessity standards, such as having failed step therapy in most cases.
When test counts are correct and medical necessity is demonstrated, Medicare handles clean electronic immune claims in 14 to 30 days. When past authorizations are still valid, and allergy tests and treatment codes are used properly, commercial payers usually pay within 30 days. When Medicaid applications are due varies by state, but they are usually 30 to 60 days. All three are reviewed by Credex Healthcare’s pre-submission review before claims are sent in. This makes sure that most immunology claims are processed within the normal timeframe for billing immunology.
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