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Cardiothoracic Surgery Billing Services Billing & RCM Services
Qualigenix codes and bills CABG, valve repair and replacement, TAVR, aortic surgery, VATS and ECMO for cardiac and thoracic surgeons in 48 states. Our surgical coders work at 98.9% coding accuracy with a 98.6% compliance and audit pass rate.
What Cardiothoracic Billing Demands
Cardiothoracic billing demands exact graft counts on every CABG, co-surgeon and team claims that match between surgeons, and tracking of 90-day global periods after each case. TAVR and transcatheter mitral repair also carry Medicare national coverage rules for heart team evaluation, modifiers and registry reporting. Qualigenix bills all of it with coders who read the full operative and catheterization record. Call 786-259-0231 for a free billing audit.
01
CABG & Valve Coding
CABG is coded by graft type: vein-only codes, arterial codes, and add-on codes when arterial and venous grafts are combined. Endoscopic vein harvest is a separate add-on. Miscounted grafts are the most common coding error.
02
Elective Case Authorizations
Elective valve, CABG and robotic or VATS thoracic cases often need authorization. Cases done outside the approved procedure or date range are denied.
03
Co-Surgeon & Team Surgery
Medicare requires both the cardiac surgeon and the interventional cardiologist to bill TAVR with modifier 62. Team surgery uses modifier 66. If only one surgeon's claim has the modifier, both can be held.
04
90-Day Global Periods
Major cardiac and thoracic procedures carry 90-day global periods. Visits for unrelated problems and returns to the OR need modifiers 24, 78 or 79 to be paid.
05
Pre-Surgery Benefit Checks
Large surgical cases mean large patient balances. Coverage and secondary insurance need checking before the admission.
06
Cath & Op Note Support
Medical necessity for CABG and valve surgery rests on catheterization findings and the surgeon's pre-op evaluation. In Medicare's 2025 audit, missing pre-op surgeon notes were the top root cause of improper payments for TAVR hospital claims.
07
Add-On Code Denials
Add-on codes for combined grafts, vein harvest and bypass support must be billed with the right primary code. Payers deny add-ons that arrive alone or with the wrong primary.
08
TAVR & TEER NCD Rules
Medicare covers TAVR under NCD 20.32 and transcatheter mitral edge-to-edge repair under NCD 20.33. Both require a heart team evaluation, and covered cases must be entered in a national registry.
PRECISION: WHAT QUALIGENIX DOES
How Qualigenix Fixes Cardiothoracic Billing Gaps
Qualigenix assigns certified surgical coders with cardiothoracic experience, and each gap has a fixed step.
Graft & Valve Charge Capture
We count grafts by type from the op note and code every add-on, including vein harvest and bypass support.
Authorization Tracking
We confirm authorizations cover the planned procedure and date, and update them when the case changes.
Modifier 62 & 66 Control
We match co-surgeon and team claims between surgeons before either is sent.
Global Period Tracking
We track each patient's 90-day window and bill separately payable care with the right modifier.
Pre-Surgery Verification
We verify primary and secondary coverage before the admission.
Operative Note Review
We check that the pre-op evaluation, cath findings and op note support the procedure, and query the surgeon when they don't.
Denial Appeals
Denials are appealed with the op note and cath report attached. Qualigenix overturns 79% of denials across its client base.
NCD & Registry Compliance
We confirm heart team documentation, Q0 and 62 modifiers, and registry participation on every TAVR and TEER claim.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
Coding for Cardiac and Thoracic Procedures
Qualigenix codes cardiac and thoracic cases for surgeons who operate in hospitals and heart centers.
CABG (33508, 33510–33536)
Venous, arterial and combined grafts, plus endoscopic vein harvest.
COMPLIANCE
How We Keep Cardiothoracic Billing Compliant
Qualigenix keeps cardiothoracic billing compliant by coding each case from the op note and cath report, applying Medicare's TAVR and TEER coverage rules under NCD 20.32 and NCD 20.33, and matching co-surgeon and team modifiers across every surgeon on the case. Underbilling grafts or add-ons loses large sums per case. Overbilling global care or unsupported co-surgery draws audits and repayment. We hold a 98.6% compliance and audit pass rate with an over- and undercoding rate under 2%. All work is HIPAA compliant, with patient data handled under strict security controls.
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Audit Pass Rate
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Variance Threshold
Why Cardiothoracic Surgeons Choose Qualigenix
Medicare's audit data for TAVR shows where heart surgery claims fail: almost entirely in documentation, often the surgeon's pre-op evaluation. Qualigenix reviews that record before the claim goes out.
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IMPROPER PAYMENT RATE
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FROM DOCUMENTATION GAPS
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FROM CODING ERRORS
$0M+
PAID IN ERROR
QUESTIONS BUYERS ASK
Frequently Asked Questions
Qualigenix quotes each practice after reviewing case volume, procedure mix and payer mix. Most groups start with a free billing audit.
Yes. We count grafts by type from the op note, then bill the vein, arterial or combined codes and the add-ons that apply, including endoscopic vein harvest.
NCD 20.32 requires a heart team, including a cardiac surgeon and an interventional cardiologist, to evaluate the patient, and requires covered cases to be entered in a national registry. Missing pre-op surgeon notes are a leading cause of improper TAVR payments in Medicare audits.
Yes. We work aged claims by dollar value and filing deadline. Across our clients, Qualigenix has cut days in A/R from 54 to 36.
Medicare requires both the cardiac surgeon and the interventional cardiologist to bill the TAVR code with modifier 62, plus modifier Q0 for the coverage-with-evidence requirement. We match both claims before they're sent.
Routine post-op care is included in the surgical payment. We bill unrelated visits with modifier 24 and related returns to the OR with modifier 78, when the note supports it.
Yes. Qualigenix works in 133 EMR/EHR platforms, including hospital systems.