Verimedix runs thoracic surgery billing services for lung, esophageal and chest-wall programs - op-note abstraction that codes the approach actually completed, staging-to-resection prior authorization, 90-day global-period discipline, co-surgery and modifier 22 substantiation, and appeals on the denials that keep complex resections in A/R.
Thoracic surgery billing services are outsourced revenue cycle management for lung, esophageal, mediastinal and chest-wall surgery. The work covers approach-accurate coding across the VATS family (32601-32674), the open resection family (32096-32540) and bronchoscopy with EBUS (31622-31654), plus mediastinoscopy (39401) and esophagectomy (43117); prior authorization for the staging-to-resection pathway; 90-day global-period management including post-op visit reporting; modifier 22, 62 and 80 support with operative-report substantiation; and appeals on the approach-coding and co-surgery denials that stall surgical revenue. Pricing typically runs 6-9% of net collections, or roughly $6-$12 per claim.
Thoracic surgery encompasses procedures on the lungs, esophagus, mediastinum, chest wall, diaphragm, and pleura—ranging from diagnostic bronchoscopy to complex pulmonary resections and esophagectomy. The most significant billing distinction is the surgical approach: video-assisted thoracic surgery (VATS) procedures have distinct CPT codes from open thoracotomy approaches, and the correct code must reflect the approach actually completed. For example, VATS lobectomy (32663) and open lobectomy (32480) are entirely different CPT codes with different RVU values. When a VATS procedure is converted to open thoracotomy intraoperatively, the surgeon must code the completed open procedure, not the originally intended VATS approach.
Most major thoracic surgical procedures carry a 90-day global period, meaning post-operative management, chest tube management, and routine follow-up are bundled. Thoracic surgeons frequently co-manage hospitalized patients with pulmonologists and intensivists (critical care), requiring careful coordination of who bills what during the post-operative period. Critical care billing (99291, 99292) is separately payable during the global period only when the critical care services are unrelated to the surgical procedure or the post-operative complications are so severe as to constitute a new clinical condition. Thoracic surgery also involves significant hospital and ICU-based billing (99221–99233 inpatient visits), which must be stratified correctly by complexity level.
Robotic-assisted thoracic surgery (RATS) uses the same CPT codes as the equivalent VATS procedures—there is no separate robotic CPT designation. Modifier -22 (increased procedural complexity) may be appropriate in cases of extraordinary complexity, but robotic technique alone does not justify -22. Payers do not pay separately for the robotic approach. Bronchoscopy (31622–31654) is frequently performed in conjunction with thoracic procedures or as a standalone diagnostic/therapeutic service, with its own coding family including bronchial thermoplasty, endobronchial ultrasound (EBUS: 31652, 31653), and transbronchial biopsy—all of which require accurate coding to capture full procedural value.
Two CY 2026 payment changes matter for thoracic revenue projections. First, the Medicare conversion factor rose to $33.4009 for most clinicians ($33.5675 for qualifying APM participants), a 3.26% increase - but CMS simultaneously applied a -2.5% efficiency adjustment to work RVUs and the intraservice portion of physician time for non-time-based services, roughly 7,700 codes. E/M, care management, behavioral health, telehealth-list and MMM-global maternity codes were excluded; the 32-series resection and 31-series bronchoscopy families were not. A thoracic practice therefore sees its procedural work RVUs trimmed while its inpatient E/M work is left alone, which shifts the revenue mix and makes correct E/M capture during and outside the global period more consequential than it was in 2025. Second, CMS continues to build its global-period dataset: post-operative visits are reported with the non-payable CPT 99024, use of modifier 54 has been expanded to cases where the surgeon anticipates furnishing only the operative portion without a formal transfer of care, and HCPCS G0559 lets a practitioner outside the surgeon's group report complex post-op assessment once per 90-day global period. Thoracic surgeons who co-manage ICU patients with pulmonology and critical care should expect this data to inform future global-period valuation - and should be documenting to it now.
Published outsourced-billing ranges run 4-10% of net collections across specialties, with 5-8% quoted most often for small and mid-sized practices - but high-complexity surgical specialties, cardiothoracic among them, are routinely quoted 10-12%. Verimedix thoracic engagements typically land at 6-9% of net collections, or roughly $6-$12 per claim for groups that prefer per-claim pricing. Where a practice sits inside that band is driven by case mix rather than volume: a program running EBUS staging, robotic and open resections, and co-surgeon esophagectomies carries far more work per claim than a practice weighted toward diagnostic bronchoscopy.
The number worth comparing a quote against is the cost of a single mishandled case. A VATS lobectomy coded as 32663 when the operative note documents conversion to open thoracotomy is both an underpayment and a compliance exposure; a resection performed without its own authorization after the staging procedure is usually unappealable; a modifier 62 mismatch between two surgical groups parks the whole esophagectomy in dispute. Surgical specialties report first-pass denial rates of roughly 13-17%, prior authorization now drives about 34% of first-pass denials, and 58-72% of prior-auth denials are overturned when they are actually appealed - which is the argument for a partner who works appeals rather than resubmits.
| Fee model | Typical range | Best fit |
|---|---|---|
| Percentage of net collections | 6-9% of net collections | Most thoracic and cardiothoracic groups; the vendor is paid only when the practice is |
| Per claim | About $6-$12 per claim | Bronchoscopy- and EBUS-heavy programs with repeatable, predictable claim types |
| Surgical coding only | Priced per case | Groups keeping A/R in-house but needing coders who read the full op note for approach and conversion |
| Prior authorization support | Add-on, per authorization | Practices whose denials cluster on the staging-to-resection authorization gap rather than on coding |
These are engagement ranges, not a rate card. Payer mix, the share of major resections versus diagnostic bronchoscopy, co-surgeon volume, hospital-employed versus independent structure and the size of an existing A/R backlog all move the quote - we price after reviewing your case mix and aging.
Below are commonly billed codes our certified coders manage for thoracic surgery practices. Always confirm payer-specific coverage and current code values.
| Code | Description | Billing note |
|---|---|---|
32663 | Thoracoscopy (VATS), surgical; with lobectomy | 90-day global; use when VATS approach completed; if converted to open, use 32480; requires documentation of approach |
32480 | Removal of lung, other than pneumonectomy; single lobe (lobectomy) | 90-day global; open thoracotomy approach; higher RVU than VATS for same anatomic procedure |
32503 | Resection of apical lung tumor (e.g., Pancoast); without chest wall resection | Complex procedure; 90-day global; frequently requires multi-specialty coordination |
32096 | Thoracotomy with diagnostic biopsy(ies) of lung infiltrate(s) | 90-day global; open biopsy; compare with VATS biopsy (32606) when approach is thoracoscopic |
31625 | Bronchoscopy, rigid or flexible, with bronchial or endobronchial biopsy(ies) | 0-day global; frequently performed with EBUS (31652) and staging procedures; document number and site of biopsies |
31652 | Bronchoscopy with transbronchial needle aspiration biopsy(ies), EBUS, first lobe/segment | EBUS-guided biopsy for mediastinal staging; add-on 31653 for each additional lobe/segment |
39401 | Mediastinoscopy; includes biopsy(ies) of mediastinal mass(es) | Diagnostic staging procedure for lung cancer; 0-day global; frequently precedes lobectomy |
43117 | Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision | 90-day global; complex multi-stage procedure; multi-specialty billing if thoracic and general surgeons each perform a portion |
Our standard operating procedures for thoracic surgery revenue cycle management — the step-by-step workflow we follow on every claim:
These are the issues we see most often in thoracic surgery billing — and exactly how we resolve them:
Coding the VATS CPT (32663) when the operative report documents conversion to open thoracotomy (32480) results in underpayment and potential compliance risk. Fix: require coders to read the entire operative report, not just the operative header—conversion documentation is often in the body of the note, not the title.
Billing critical care (99291) during the 90-day global period for post-operative complications related to the surgery is not separately payable. Fix: establish a clear documentation standard requiring the critical care note to explicitly state whether the condition requiring critical care is related or unrelated to the procedure.
Practices performing EBUS bronchoscopy for mediastinal staging (31652, 31653) frequently only bill the basic bronchoscopy code (31625), missing add-on codes for additional sampled stations. Fix: implement an EBUS procedure note template that prompts documentation of each lymph node station sampled, supporting billing of 31653 for each additional station.
For esophagectomy or procedures with separate abdominal and thoracic phases performed by two surgeons, the incorrect application (or omission) of -62 leads to payment disputes. Fix: coordinate modifier usage between both surgical groups before claim submission; document each surgeon's distinct contribution in separate operative dictation.
Thoracic cancer patients often require a staging procedure (mediastinoscopy, EBUS) followed by a separate resection surgery; each requires its own authorization. Failure to obtain authorization for the resection after the staging procedure results in denial. Fix: implement a staging-to-resection authorization workflow with automatic follow-up triggers when staging findings indicate resection is planned.
Verimedix works inside the systems thoracic surgery practices already use, including:
Verimedix thoracic engagements typically run 6-9% of net collections, or about $6-$12 per claim on a per-claim model. Published outsourced-billing ranges sit at 4-10% across specialties, with high-complexity surgical specialties often quoted 10-12%. Case mix - EBUS staging volume, co-surgeon esophagectomies, robotic and open resections - moves the number more than claim count does.
The CY 2026 Medicare conversion factor rose 3.26% to $33.4009 ($33.5675 for qualifying APM participants), but CMS applied a -2.5% efficiency adjustment to work RVUs and intraservice time for about 7,700 non-time-based codes, including thoracic resection and bronchoscopy families. E/M and time-based services were excluded, so procedural payment tightened while inpatient management did not.
Robotic-assisted thoracic procedures are coded with the same CPT codes as their VATS equivalents—there is no separate CPT for robotic surgery. The operative report should document the robotic approach. Modifier -22 is not appropriate solely because a robotic platform was used; it applies only when the overall complexity significantly exceeded standard.
Yes, if the bronchoscopy was a separate, distinct service with its own indication and documentation. Apply modifier -59 to the bronchoscopy code. NCCI edits should be reviewed to confirm the specific code pair is eligible for separate billing with -59.
Endobronchial ultrasound (EBUS) is a bronchoscopic technique for real-time ultrasound-guided needle biopsy of mediastinal and hilar lymph nodes. CPT 31652 covers the bronchoscopy with EBUS and transbronchial needle aspiration for the first lobe or segment; CPT 31653 is the add-on code for each additional lobe or segment sampled in the same session.
Bill the procedure actually performed—pneumonectomy (32440 for open, or appropriate VATS equivalent). The pre-operative plan does not determine the CPT code; the completed procedure does. Document the reason for conversion in the operative report.
Common diagnoses include: C34.10–C34.92 (malignant neoplasm of bronchus/lung by site), C38.0–C38.4 (malignant neoplasm of heart/mediastinum/pleura), J93.11 (primary spontaneous pneumothorax), J86.0 (pyothorax with fistula), K22.10 (ulcerative esophagitis), and Z12.11 (lung cancer screening encounter) for low-dose CT screening.
Low-dose CT lung cancer screening uses CPT 71271 (CT thorax, low dose, for lung cancer screening). The ICD-10 code Z12.11 (encounter for screening for malignant neoplasm of lung) and Z87.891 (history of tobacco use) are common associated diagnoses. Medicare covers this as a preventive benefit for qualifying beneficiaries aged 50–80 with a 20 pack-year smoking history.
Verimedix handles the entire thoracic surgery revenue cycle — coding, submission, denials, and A/R — so your team can focus on patients.