Cardiothoracic Surgery Billing

Cardiothoracic Surgery Billing

General Surgery Medical BillingCardiothoracic surgery billing is a complex billing process that takes the billing procedures of other practices into consideration. Like any other major surgical billing process, cardiothoracic surgery requires the collaboration of other medical specialties in order to perform the procedure. In all cases of these kinds of surgeries, the assistance of anesthesiologists is required.

Since cardiothoracic surgeries are done mostly in major medical facilities, it is usually billed through inpatient hospital billing codes that use the Medical Severity Diagnosis Related Group (MSD-RG) classification system. This system assigns billing codes based on the International Classification of Diseases, Ninth Revision, and Clinical Modification, otherwise known as ICD-9-CM diagnosis and procedural codes.

Reimbursement Systems

Medical billing for anesthesiologyCardiothoracic surgery billing is reimbursed using several types of payment classification systems. These are as follows:

  • Physician Billing Codes – Clinicians and medical offices use the Clinical Procedural Terminology (CPT) codes to classify billing procedures and diagnostics on the bills sent to the insurer. The CPT codes are further defined by a universal coding system designed by the Centers for Medicare and Medicaid Services (CMS). Each Clinical Procedural Terminology code is assigned with its own relative value units (RVUs), to put a subsequent value on the service, procedure, or diagnosis made by the cardio thoracic surgeon.
  • CPT codes – These are billed in relation to the surgeon and the equipment used in the procedure. In some cases, the procedures claimed through Physician Billing Codes may be subject to the CMS multiple reduction rule, where all payments are reduced up to 50% except the procedure with the greatest relative value units. Relative value units are always paid at 100%, except for exclusions indicated in the Clinical Procedural Terminology or by the insurer’s/payer’s policy.

Inpatient Hospital Reimbursement Codes

CMS reimburses inpatient hospital services with the Inpatient Prospective Payment System or IPPS, which bases the payment on the universally-used Medical Severity Diagnosis Related Group (MSD-RG) classification system. The charges for the services, length of stay, and supplies used during the length of the admission are compiled into a single MS-DRG payment rate for each patient. MS-DRG payments are usually uniform regardless of the intensity of the treatment, the length of the patient’s stay in the facility, or the number of procedures performed on the patient.

The MS-DRG classification system is commonly determined by the patient’s initial diagnosis that would lead to the admission. MS-DRG payments are indicated by ICD-9-CM codes on a billing form to identify the type of service rendered by the patient during the length of the patient’s admission.

Revenue Codes

Revenue codes assist in identifying services provided by the revenue center. Medicare uses revenue codes in quantifying claims for reporting purposes. Medicare requires the revenue codes to be included for every service on a CMS 1450 claim form or UB-04. It’s appropriate for Medical Billing for Cardiothoracicmedical facilities to indicate the cost of products used for the procedures on a cardiothoracic surgery within the Medical/Surgical Supply – Other Implant classification or Revenue Code 0278, Operating Room Services – General or Revenue Code 0360.

Medical facilities utilize the Health Care Common Procedural Coding System (HCPCS) in coding procedures in a cardiothoracic surgery. These include the Level I codes or CPT codes, Level II codes for supplies and other products not included in the CPT codes, and Level II HCPCS codes including C codes, which are used in conjunction with the Medicare Prospective Payment System, and used for outpatient procedures as well.

These code classifications are required to ensure that all relative data to the cardiothoracic surgery is aptly documented and consistent with each other. Additionally, these codes are classified in a way to prevent double charges or double reimbursements resulting from one procedure.

MPMR provides medical billing services for cardiothoracic surgery practices nationwide. With over 20 years of experience, MPMR is well trusted with its Certified Coders and Billing Specialists. Call for a free consultation today!

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