Heart surgery practices

Cardiac Surgery Billing

Q: Why do cardiac surgery claims get denied so often?

Most denials come from a small set of causes: missing or conflicting modifiers when more than one surgeon bills, post-operative visits billed inside the global period, missing prior authorisation, and documentation that does not support the level of complexity claimed. Each of those is preventable before submission.

Q: Can you bill for the surgeon and the assistant on the same case?

Yes. We prepare both claims together so they reference the same procedure and use consistent modifiers. Whether an assistant can be paid at all depends on the procedure and the payer — Medicare publishes an assistant-at-surgery indicator for each code — so we check that before the assistant’s claim goes out.

Billing for heart surgery and cardiothoracic practices — global periods, co-surgeon and assistant claims, and the modifier logic that decides whether a high-value case is paid in full.

A cardiothoracic surgeon reviewing an operative summary with a Billmax MD billing liaison

90 days, per case
Global period tracking: Filed in agreement
Multi-surgeon claims: Before every submission
Modifier review

What this actually involves

A single cardiac surgery case can carry more revenue than a week of office visits, and it has more ways to go wrong. Bypass and valve procedures sit inside a 90-day global surgical period, so every post-operative visit has to be judged as included or separately billable. Many cases involve two surgeons or an assistant, each filing their own claim with modifiers that must agree with each other. Procedures are frequently inpatient-only under Medicare and often need prior authorisation first. We handle this for surgeons and cardiothoracic groups end to end, so complex cases are coded to what the operative note supports and paid the first time.

How we run it

1
Read the operative note
Grafts, valves, bypass time and any unusual complexity are coded from the surgeon’s own documentation, not a charge slip.
2
Coordinate the surgical team
Primary surgeon, co-surgeon and assistant claims are checked against each other so the modifiers and codes agree before any claim is sent.
3
Track the global period
Each case opens a 90-day window. Follow-up visits are flagged as included or billable, so nothing is double-billed and nothing billable is missed.
4
Defend high-value claims
When a large claim is denied or underpaid, the appeal goes out with the operative report and the payer’s own coverage policy attached.

Questions