- +1 (773) 985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Our professionals at Stream RCM are associated with thoracic surgeons and pulmonary surgical teams who assist in creating clear and defendable claims related to lobectomies, thoracotomies, mediastinoscopy, and pleural surgeries. We stay aware of all the modifier rules, global periods, and other payer-specific bundling edits so that you can get paid for the entire surgical work.
Thoracic Surgery Billing Services do not fail because the surgeons operate on the patient inefficiently, but due to improper coding of such operations as VATS lobectomy, wedge resection, and mediastinal lymph node dissection. However, our professionals are well familiar with details of the 32600 series for VATS and the complexities of 90 days global periods. We operate within surgical and pulmonology specializations, which allows us to make sure that all claims submitted will be thoroughly reviewed by those who are already aware of thoracic anatomy, operative reports, and payer nuance. The work of Thoracic Surgery Billing Services demands constant monitoring of changes in CPT/ICD-10 coding, RVU calculations, and new CMS site-neutral payment policy. Our specialists have proper coding certification and undergo additional specialty training to know thoracic and cardiothoracic surgeries inside out.
In billing lobectomy, segmentectomy, and pneumonectomy claims, we match the procedure performed to the operative note, ensuring that open surgery and video-assisted surgery are never billed interchangeably.
Our coding team codes the surgeries like esophagectomy, fundoplication, and reconstructive surgery with care taken into account for bundling of related procedures done on the same operating day.
The reconstructive element is documented separately from rib resection through chest wall reconstruction with grafts to make sure that the extra work is considered in reimbursement.
Proper modification code is used for the procedure of mediastinoscopy and mediastinal mass excisions done along with resections to avoid bundled payment write-offs for physicians.
Pleurodesis, decortication, and empyema drainage claims use the level of diagnosis specificity that payers require, thereby eliminating the back-and-forth involved in pleural claim payments.
Thoracic surgery billing is continuously changing. We simplify the billing process by being efficient and reducing mistakes, delays, and increasing revenue for your practice.
We guarantee that all surgery coding is done properly based on operative reports, thereby avoiding any revenue losses incurred as a result of complicated surgeries such as VATS and open thoracotomies.
Our denied claims are challenged with specialty specific letters. Our root cause analysis focuses on problems that keep recurring such as incorrect usage of modifiers, guaranteeing a 98% first-pass resolution rate.
We reduce your days in AR through follow-ups on aging accounts. We ensure that you get paid for what you deserve for your most profitable cases with our continuous follow-ups.
We make sure that the coverage is confirmed and prior authorizations are obtained before performing any surgery to avoid denial because of lack of medical necessity.
Our dashboard analytics will offer you valuable insight into the financial performance of your thoracic surgery practice by benchmarking your results against industry standards.
We conduct regular internal audits of your coding and documentation to make sure that your work is in compliance with the changing CMS and STS guidelines.
CMS may remove most general thoracic procedures from the inpatient-only list. Prepare your billing now.
A group of surgeons in the thoracic field who was managing internal billing and coding before they were outsourced to Stream RCM. This group was experiencing a denial rate of over 18% due to modifiers mistakes and missing prior authorizations in lobectomy and mediastinoscopy claims. In four months, after the process of outsourcing to us, the denial rate decreased to 5%.
The difference didn’t come from the result of extra efforts. It came from having coders and billers who are coding and billing for thoracic services daily instead of sometimes. This process doesn’t require any extra effort from physicians. It helps to shift the responsibility of monitoring changes in bundling by payers and RVUs to the people responsible for correct billing.
Medical coding for thoracic medicine requires knowing the right code for the surgery performed and having a diagnosis that is detailed enough to pass the insurance claim review. Our coders keep record of these codes for each operation that we get.
| CPT Code | ICD-10 Example | Stream RCM Approach |
|---|---|---|
| 32480 (Lobectomy) | C34.9 (Lung Cancer) | We make sure that we have done the proper linking of oncologic resection and record the 90 days global period in order to capture the post-op complications individually. |
| 32663 (VATS Lobectomy) | C34.1 (Upper Lobe) | We confirm the surgical procedure and assign the correct modifier code to differentiate the procedure from an open procedure, thus avoiding payer bundling edits. |
| 43107 (Esophagectomy) | C15.3 (Esophagus) | Our team manages the challenge associated with abdominal and thoracic approach documentation to make sure this expensive procedure gets reimbursed correctly. |
| 32551 (Chest Tube) | J94.2 (Hemothorax) | Modifier -50 is used to indicate bilateral placements whenever applicable, ensuring that the payer appreciates the total scope of the procedure. |
| 32601 (Thoracoscopy) (Chest Tube) | R91.1 (Nodule) | The distinction between the diagnostic nature and surgical procedure is meticulously documented by us in order to avoid down coding and ensure correct APC reimbursement. |
Robotic-Assisted Thoracic Surgery (RATS) introduces a whole new dimension in terms of coding challenges. Contrary to the VATS and Open surgeries, robotic surgeries have their own special codes and the need for precise documentation for the utilization of the robotic system. Stream RCM is right there to make sure that you are appropriately billed for these highly technical procedures. We know the details of billing the da Vinci system, and any other robotic platform for that matter, and analyze the operative notes in detail to bill for any expenses incurred during the procedure. We make sure that your case does not fall into the trap of denial due to “medical necessity” for robotic surgery, and the appropriate segregation of the facility and professional component. With the increasing number of robotic lung resections and thymectomies, our expertise will definitely pay off.
Our team seamlessly integrates into the EMR/EHR you already use. Your documentation stays intact. We simply extract what we need to facilitate billing, coding, and claims.
Lung cancer treatments have become more complicated due to the use of immunotherapy and targeted therapies; thoracic surgeons need to collaborate with oncologists. Stream RCM helps to ensure that the surgical aspect of the multi-specialty treatments will be billed correctly. We work with other specialists to make sure that modifiers such as modifier -25 are used correctly when there are separately identifiable E/M services provided and also to make sure that there is no billing of the same procedure twice. With our efficient billing of both surgical and oncological treatments, we make sure that the contributions of the thoracic surgeon are well documented and compensated for.
Every thoracic billing company faces these recurring obstacles; here is the real problem and exactly how we resolve each one.
We are the premier Thoracic Surgery Billing Company committed to increasing your revenue.
Our group comprises coders who are highly trained in advanced surgical certifications that involve the complexities of thoracic surgeries.
Instead of simply reacting to denials, we make sure they never happen by providing real-time modifier, global period, and payer-specific edits for your surgery.
By acting as an extension of your office, we make sure that you get enough time to save lives without having to worry about anything else.
We offer in-depth revenue cycle dashboards for all your procedures and payers that will help surgeons see results.
Modifiers missing (-50 for bilateral), linkage mistakes for ICD-10 diagnosis codes, and unbundling of combined procedures are among the common reasons for claim rejections. We avoid these issues by conducting thorough checks before submission.
Frequently billed codes include 32663 for VATS lobectomy, 32100 for open thoracotomy, 39401 for mediastinoscopy, 32601 for diagnostic thoracoscopy, and 31652 for endobronchial ultrasound sampling procedures.
Yes, we specialize in the specific coding and documentation requirements for RATS. We ensure all robotic add-on codes are correctly applied and medical necessity is clearly demonstrated to prevent denials.
We reduce Days in AR to under 30 days, lower denial rates to below 5%, and provide transparent analytics, allowing you to see exactly where your revenue is coming from and where it’s being held up.
Absolutely. We align our billing documentation with the requirements of the Society of Thoracic Surgeons National Database, ensuring your data is consistent and compliant with clinical registries.
Talk to a thoracic surgery billing specialist about what your practice could recover.
