Thoracic Surgery Billing: VATS Coding, Lung Resections, Global Periods, and Denial Prevention

Thoracic surgery involves some of the most complex procedures performed within the chest.

A thoracic surgeon may remove part of a lung, perform a minimally invasive VATS procedure, treat pleural disease, operate on the mediastinum, manage an esophageal condition, perform bronchoscopy, or convert a minimally invasive operation to an open thoracotomy when clinical circumstances require it.

Each of these situations can change how the claim should be reported.

That makes Thoracic Surgery Billing much more complex than simply matching a procedure name to a CPT code.

Accurate reimbursement may depend on understanding:

• Whether the surgery was open or thoracoscopic
• The exact amount of lung tissue removed
• Which lobe or segment was treated
• Whether a biopsy was diagnostic or part of a larger resection
• Whether bronchoscopy was separately reportable
• Whether pleural procedures were included in another operation
• Which additional procedures were performed
• Whether global surgery rules apply
• Whether prior authorization matched the final procedure
• Whether modifiers are supported
• Whether the operative report contains enough detail for accurate coding

The complexity increases when several services occur during the same operative session.

For example, a patient with a suspicious lung lesion may undergo bronchoscopy, thoracoscopy, wedge resection, lymph-node evaluation, and a larger anatomical lung resection during one surgical encounter.

The billing team cannot assume that every clinical step described in the operative note generates a separate payable code.

Instead, the complete surgical encounter must be reviewed to determine which services are separately reportable and which are included in the primary procedure.

A strong thoracic surgery revenue cycle therefore connects:

• Eligibility verification
• Prior authorization
• Surgical scheduling
• Operative documentation
• Charge capture
• CPT coding
• Diagnosis coding
• NCCI review
• Modifier selection
• Claim submission
• Payment posting
• Denial management
• Underpayment review
• Accounts receivable follow-up

This guide explains how Thoracic Surgery Billing works, what makes it different from general surgical billing, which procedures create the greatest coding complexity, and how practices can build stronger workflows around high-value thoracic claims.

What Is Thoracic Surgery Billing?

Thoracic Surgery Billing is the process of documenting, coding, submitting, and managing claims for surgical and related medical services involving structures within the chest.

For this guide, the focus is primarily on general thoracic surgery, including services involving:

• Lungs
• Pleura
• Mediastinum
• Esophagus
• Chest wall
• Diaphragm
• Airways
• Related thoracic structures

Common thoracic procedures may include:

• Video-assisted thoracoscopic surgery
• Wedge resection
• Segmentectomy
• Lobectomy
• Bilobectomy
• Pneumonectomy
• Lung biopsy
• Bronchoscopy
• Pleural drainage
• Pleurodesis
• Decortication
• Mediastinal procedures
• Lymph-node procedures
• Thymectomy
• Esophagectomy
• Chest wall procedures

A complete billing workflow may involve:

• Insurance verification
• Authorization
• Medical necessity review
• Procedure scheduling
• Preoperative services
• Operative documentation
• Charge capture
• Coding
• Modifier review
• Global-period review
• Claim submission
• Payment posting
• Denial resolution
• AR follow-up

The coding team needs to understand not only what condition the surgeon treated, but also exactly how the procedure was performed.

That distinction is particularly important in thoracic surgery because similar clinical goals can be achieved through different surgical approaches.

General Thoracic Surgery vs Cardiothoracic Surgery Billing

The term “thoracic surgery” is sometimes used broadly enough to include both cardiac and non-cardiac chest surgery.

However, general thoracic surgery usually focuses on structures such as:

• Lungs
• Esophagus
• Pleura
• Mediastinum
• Chest wall
• Diaphragm

Cardiac surgery involves a different group of procedures such as:

• Coronary artery bypass grafting
• Heart valve surgery
• Other cardiac operations

These areas can overlap within cardiothoracic practices, but their coding structures are very different.

For this reason, a billing workflow designed for general thoracic surgery should not treat lung and esophageal procedures as if they follow the same rules as cardiac surgery.

This article focuses on the general thoracic revenue cycle, where VATS, pulmonary resection, bronchoscopy, pleural procedures, mediastinal surgery, and esophageal procedures create the primary billing challenges.

Why Thoracic Surgery Billing Is So Complex

Thoracic surgery combines complex anatomy, multiple surgical approaches, high-value procedures, and extensive postoperative care.

Several factors make billing especially difficult.

Surgical Approach Can Change the Coding Pathway

A thoracic procedure may be performed through:

• Open thoracotomy
• VATS
• Robotic-assisted thoracoscopic technique

The underlying clinical goal may be similar, but the reporting pathway can change depending on the approach.

The billing team therefore needs to know what procedure was actually completed, not merely what was originally scheduled.

If a VATS procedure is converted to open surgery, the final operative report needs to clearly describe that conversion and the definitive operation performed.

The Extent of Lung Resection Matters

Removing a small wedge of lung tissue is not the same as removing an anatomical segment or an entire lobe.

Thoracic surgery coding may distinguish among:

• Wedge resection
• Segmentectomy
• Lobectomy
• Bilobectomy
• Pneumonectomy

The operative note should identify the exact extent of resection.

A vague statement such as:

“Lung mass removed”

may not provide enough detail for accurate coding.

Diagnostic and Therapeutic Procedures May Occur Together

Thoracic surgery often includes both diagnostic and therapeutic work during the same encounter.

Examples may include:

• Bronchoscopy before surgery
• Lung biopsy
• Thoracoscopic evaluation
• Lymph-node sampling
• Definitive lung resection

The presence of several procedures in the operative report does not mean they are all independently payable.

Bundling rules must be reviewed before claim submission.

High-Value Claims Receive Greater Payer Scrutiny

Thoracic operations can generate significant reimbursement.

High-value claims may face:

• Prior authorization review
• Medical necessity review
• Medical record requests
• Coding edits
• Bundling edits
• Global-period review

A documentation problem that might create a modest delay on a routine office claim can have a much larger financial impact when it affects a major surgical procedure.

Major Services Involved in Thoracic Surgery Billing

Thoracic practices can generate claims across several different surgical categories.

Each category has its own documentation and coding considerations.

Video-Assisted Thoracoscopic Surgery

VATS allows surgeons to perform many thoracic operations through a minimally invasive approach.

VATS may be used for:

• Lung biopsy
• Wedge resection
• Segmentectomy
• Lobectomy
• Pleural procedures
• Mediastinal procedures
• Other thoracic operations

The billing team needs to determine:

• Procedure performed
• Side
• Anatomical structure
• Extent of resection
• Whether additional procedures occurred
• Whether conversion to open surgery occurred

The abbreviation “VATS” alone is not enough for coding.

The operative report should explain exactly what the surgeon accomplished through the thoracoscopic approach.

VATS Converted to Open Surgery

A procedure may begin thoracoscopically but require conversion to open thoracotomy because of:

• Bleeding
• Difficult anatomy
• Adhesions
• Tumor extent
• Inability to safely complete the planned procedure

The billing team should code according to the completed operation and applicable coding rules.

The operative report should clearly describe:

• Initial approach
• Reason for conversion
• Open procedure performed
• Final extent of surgery

Without this information, the scheduled procedure may incorrectly influence charge capture.

Lung Resection Billing

Pulmonary resections represent one of the most important areas of Thoracic Surgery Billing.

The correct billing pathway depends on how much lung was removed and the surgical approach used.

Wedge Resection

A wedge resection removes a non-anatomical portion of lung tissue.

It may be performed for:

• Diagnostic evaluation
• Treatment of a pulmonary lesion
• Metastatic disease
• Other clinical reasons

Documentation should identify:

• Lung
• Side
• Lobe
• Lesion
• Purpose of resection
• Surgical approach
• Number of resections when applicable

The distinction between diagnostic and therapeutic work can affect the coding analysis when additional procedures occur during the same encounter.

Segmentectomy

A segmentectomy removes an anatomical bronchopulmonary segment.

The operative report should clearly identify:

• Segment removed
• Lobe
• Side
• Surgical approach
• Associated lymph-node work
• Additional procedures

This distinction matters because segmentectomy is more extensive than a wedge resection but less extensive than removal of an entire lobe.

Lobectomy

A lobectomy removes an entire lobe of the lung.

Documentation should clearly identify:

• Right or left lung
• Lobe removed
• Open or thoracoscopic approach
• Additional resections
• Lymph-node procedures when performed
• Other associated services

Because lobectomy is a major operation, the claim should receive careful review before submission.

Bilobectomy and Pneumonectomy

More extensive resections may include removal of two lobes or an entire lung.

These high-value procedures require complete operative documentation supporting:

• Extent of resection
• Side
• Approach
• Diagnosis
• Additional services
• Postoperative management

The billing team should avoid relying on abbreviated surgical scheduling terminology for these cases.

Lung Biopsy Billing

Lung biopsy creates an important bundling issue in thoracic surgery.

A biopsy may be performed before the surgeon determines whether a larger resection is necessary.

For example, the surgeon may perform a wedge biopsy and then proceed to a lobectomy based on the findings.

Whether the biopsy is separately reportable depends on factors including:

• Anatomical location
• Relationship to the tissue subsequently removed
• Final procedure performed
• Applicable bundling rules

When a biopsy is taken from tissue that is then removed as part of a larger procedure, separate reporting may not be appropriate.

This is why the operative report should identify the precise biopsy location.

The billing team needs to understand whether the biopsy involved:

• The same anatomical area subsequently resected
• A separate lesion
• A different lobe or location
• A diagnostic site not included in the final resection

Bronchoscopy in Thoracic Surgery

Bronchoscopy is frequently performed around thoracic surgery.

It may be used to:

• Evaluate an airway lesion
• Obtain a diagnostic specimen
• Inspect the airway
• Confirm anatomy
• Assist surgical planning

The billing question is whether the bronchoscopy represents a separately supported diagnostic service or routine work related to the thoracic operation.

A bronchoscopy performed only to assess anatomy before surgery may follow a different billing pathway from a separately necessary diagnostic bronchoscopy.

Documentation should identify:

• Reason for bronchoscopy
• Findings
• Diagnostic work performed
• Relationship to the subsequent surgery

The billing team should review the complete encounter before reporting the bronchoscopy separately.

Pleural Procedures

Thoracic surgeons treat a range of pleural conditions.

Services may include:

• Thoracentesis
• Chest tube placement
• Pleural drainage
• Pleurodesis
• Pleurectomy
• Decortication
• Empyema treatment

Billing can become complicated when pleural services are performed during a larger thoracic operation.

Chest Tube Placement

Chest tubes may be placed for:

• Pneumothorax
• Hemothorax
• Pleural effusion
• Postoperative drainage
• Other thoracic conditions

When chest tube placement is part of another open thoracic operation, the service may be included within the larger procedure rather than separately reportable.

The clinical record should clearly identify when a chest tube represents independent treatment versus routine surgical drainage.

Pleurodesis

Pleurodesis may be performed for conditions such as:

• Recurrent pleural effusion
• Pneumothorax
• Malignant pleural disease

The operative note should document:

• Indication
• Approach
• Method
• Side
• Additional procedures

Decortication

Decortication may be necessary for conditions involving:

• Empyema
• Fibrous pleural restriction
• Trapped lung

Documentation should describe the extent of the procedure and the clinical reason for surgery.

The billing team should also review whether other pleural services are included in the primary operation.

Mediastinal Procedures

Thoracic surgeons also perform procedures involving the mediastinum.

These may include:

• Mediastinoscopy
• Mediastinal biopsy
• Mediastinal mass excision
• Thymectomy
• Lymph-node procedures
• Other mediastinal operations

The billing team needs clear documentation of:

• Anatomical site
• Approach
• Procedure performed
• Tissue removed
• Diagnostic vs therapeutic intent
• Additional procedures

Mediastinal surgery should not be treated as an extension of lung-resection coding.

It represents its own procedural category with different coding considerations.

Lymph-Node Procedures

Lymph-node evaluation is common in thoracic oncology.

A patient undergoing lung cancer surgery may also have:

• Lymph-node sampling
• Lymphadenectomy
• Mediastinal node evaluation

The operative note should identify:

• Nodes or stations addressed
• Procedure performed
• Relationship to the primary operation

The billing team should review whether the lymph-node procedure is separately reportable under the applicable coding rules.

Simply stating that “nodes were removed” may not provide enough information.

Esophageal Surgery Billing

General thoracic surgeons may perform significant esophageal procedures.

These may include:

• Esophagectomy
• Esophageal resection
• Hiatal or paraesophageal procedures
• Endoscopic esophageal procedures
• Other complex esophageal operations

Esophageal billing deserves separate attention because procedure selection may depend on:

• Surgical approach
• Extent of resection
• Reconstruction
• Anatomical route
• Additional procedures

The operative report should clearly describe the complete surgery.

An esophagectomy should not be coded from a short procedure title without reviewing the actual approach and operative details.

Chest Wall and Diaphragm Procedures

Thoracic surgeons may also treat conditions involving:

• Chest wall tumors
• Rib abnormalities
• Traumatic injuries
• Diaphragm defects
• Other thoracic structures

These cases may require:

• Resection
• Reconstruction
• Repair
• Additional surgical services

The billing team should determine whether multiple procedures are independently reportable or included in the primary operation.

Complete operative documentation is especially important when reconstruction accompanies resection.

Robotic-Assisted Thoracic Surgery

Robotic technology may be used to perform:

• Lobectomy
• Segmentectomy
• Wedge resection
• Mediastinal procedures
• Esophageal procedures
• Other minimally invasive thoracic operations

The use of a robot does not automatically create a separate physician procedure code.

The claim should represent the actual surgery performed and the applicable procedural approach.

Documentation should still clearly identify:

• Operation completed
• Side
• Anatomy
• Extent of resection
• Additional procedures
• Conversion when applicable

The robot is a surgical technique, not a substitute for precise procedure documentation.

The Thoracic Surgery Billing Workflow

A strong Thoracic Surgery Billing workflow begins before surgery.

Major thoracic procedures may require substantial clinical and administrative preparation before the claim can ever be submitted.

The process commonly includes:

1. Patient registration
2. Insurance verification
3. Medical necessity review
4. Prior authorization
5. Surgical scheduling
6. Procedure performed
7. Operative report completion
8. Charge capture
9. Coding and NCCI review
10. Modifier and global-period review
11. Claim submission
12. Payment posting
13. Underpayment and denial review
14. AR follow-up

Thoracic Surgery Billing Workflow Explained

Step	Purpose
Patient Registration	Collects patient demographics, insurance information, referral details, and scheduled procedure information.
Insurance Verification	Confirms active coverage, surgical benefits, patient responsibility, and payer requirements.
Medical Necessity Review	Confirms that the diagnosis, imaging, symptoms, and clinical history support the planned thoracic procedure.
Prior Authorization	Determines whether the procedure requires approval and confirms the authorized service, provider, and site of care.
Surgical Scheduling	Coordinates the planned procedure, approach, facility, surgeon, and authorization information.
Procedure	The thoracic surgeon performs the open, VATS, robotic-assisted, pulmonary, pleural, mediastinal, or esophageal procedure.
Operative Report	Documents the final approach, anatomy, extent of resection, additional procedures, findings, and surgical outcome.
Charge Capture	Identifies potentially reportable services from the completed operation rather than relying only on the scheduled procedure.
Coding and NCCI Review	Assigns procedure and diagnosis codes while reviewing lung resections, biopsies, bronchoscopy, pleural services, and bundled procedures.
Modifier and Global Review	Determines whether modifiers or postoperative global surgery rules affect the claim.
Claim Submission	Sends the completed claim to the appropriate payer.
Payment Posting	Records reimbursement, contractual adjustments, patient responsibility, and payer reductions.
Denial and Underpayment Review	Identifies coding, authorization, documentation, bundling, medical necessity, or payment problems.
AR Follow-Up	Tracks unresolved surgical claims until the account is appropriately resolved.

Why the Operative Report Is Critical in Thoracic Surgery Billing

The operative report is the foundation of an accurate thoracic surgery claim.

Important coding decisions may not be possible from:

• Scheduling information
• Authorization description
• Procedure title
• Charge ticket

The final operative report needs to explain exactly what occurred in the operating room.

Surgical Approach

The report should clearly identify whether the operation was:

• Open
• Thoracoscopic
• Robotic-assisted
• Converted from minimally invasive to open

The final completed approach can directly affect procedure selection.

Laterality and Anatomical Location

Documentation should identify:

• Right or left side
• Lobe
• Segment
• Lesion
• Pleural space
• Mediastinal structure
• Esophageal location when relevant

General phrases such as “lung lesion” may not provide the specificity necessary for accurate coding.

Extent of Lung Resection

For pulmonary surgery, the operative note should clearly distinguish:

• Biopsy
• Wedge resection
• Segmentectomy
• Lobectomy
• More extensive resection

This prevents the billing team from making assumptions about the amount of tissue removed.

Additional Procedures

The report should also identify services such as:

• Bronchoscopy
• Lymph-node procedures
• Pleural procedures
• Chest wall repair
• Additional lung resection

Each service should then be reviewed for separate reporting and bundling.

Conversion of Surgical Approach

When a minimally invasive procedure converts to open surgery, documentation should explain:

• Original approach
• Reason for conversion
• Procedure ultimately completed

This helps the coding team represent the final surgery correctly.

Prior Authorization in Thoracic Surgery Billing

Prior authorization can significantly affect reimbursement for major thoracic procedures.

Payers may review procedures involving:

• Lung resection
• Esophageal surgery
• Selected pleural procedures
• Other high-cost interventions

The authorization workflow should confirm:

• Diagnosis
• Planned procedure
• Surgical approach when required
• Provider
• Facility
• Effective dates
• Medical necessity criteria

Authorization Should Match the Final Procedure

Thoracic operations may change once the surgeon evaluates the anatomy directly.

A planned wedge resection, for example, may progress to a more extensive lung resection based on intraoperative findings.

The practice should have a process for determining whether the changed procedure requires:

• Updated authorization
• Additional payer notification
• Supporting documentation
• Further medical necessity review

An authorization number alone does not guarantee payment if it does not correspond to the procedure ultimately performed.

Global Surgery Considerations Begin With the Initial Procedure

Major thoracic operations frequently lead to a substantial postoperative care period.

The billing team should know the applicable global indicator for the specific procedure rather than assuming every thoracic service follows the same global period.

Postoperative encounters may involve:

• Routine surgical follow-up
• Wound care
• Recovery assessment
• Staged procedures
• Complications
• Return to the operating room
• Unrelated medical conditions

Some of these services may be included in the global surgical package, while others may be separately reportable when requirements are met.

Common Thoracic Surgery Billing Challenges

Challenge	Potential Impact on the Practice
VATS vs Open Coding Error	The claim may not reflect the final surgical approach, particularly when a minimally invasive procedure converts to open surgery.
Incorrect Lung Resection Coding	Failure to distinguish wedge resection, segmentectomy, lobectomy, or more extensive surgery can affect reimbursement.
Lung Biopsy Bundling	A biopsy may be incorrectly reported separately when it is included in tissue removed during a larger resection.
Bronchoscopy Bundling	A bronchoscopy performed as routine surgical assessment may be incorrectly billed as a separate diagnostic procedure.
Chest Tube or Pleural Bundling	Services integral to a larger thoracic operation may be reported separately and trigger payer edits.
Incomplete Operative Documentation	Missing approach, anatomy, extent of resection, or additional procedure details can delay coding and claim submission.
Authorization Mismatch	The final surgery may differ from the originally approved procedure, creating payment risk.
Global Period Errors	Routine postoperative care may be billed separately, or legitimate separately reportable services may be missed.
High-Value Claim Delays	Complex surgical claims may remain unpaid for extended periods when they do not receive targeted follow-up.
Underpayments	A claim may be marked as paid even though reimbursement does not match the expected allowed amount.

Thoracic surgery coding requires the billing team to understand the complete operative encounter rather than select a CPT code from the scheduled procedure alone.

A single thoracic operation may involve:

• Bronchoscopy
• Diagnostic thoracoscopy
• Lung biopsy
• Wedge resection
• Anatomical lung resection
• Lymph-node evaluation
• Pleural procedures
• Chest tube placement
• Conversion from VATS to open surgery

Some of these services may be separately reportable. Others may be included in the definitive procedure.

The coding team therefore needs to determine:

• What procedure was actually completed
• Which surgical approach was used
• Which side was treated
• What portion of the lung was removed
• Whether multiple lesions or anatomical sites were involved
• Whether diagnostic work led to a larger operation
• Whether services are bundled under NCCI
• Whether global surgery rules affect the claim
• Whether a modifier is supported

The Society of Thoracic Surgeons’ current coding curriculum separately addresses open lung resections, thoracoscopic lung resections, pleural procedures, bronchoscopy, mediastinal surgery, and other general thoracic procedures, reflecting how different the coding logic can be across these service categories.

Thoracic Surgery CPT Coding

Thoracic surgery CPT coding covers multiple procedure families.

Common categories include:

• Open pulmonary resections
• Thoracoscopic/VATS pulmonary resections
• Thoracoscopy
• Pleural procedures
• Bronchoscopy
• Mediastinal procedures
• Lymph-node surgery
• Esophageal surgery
• Chest wall procedures
• Diaphragmatic procedures

Code selection should begin with the operative report.

The coder should determine:

• Open vs thoracoscopic approach
• Therapeutic vs diagnostic intent
• Anatomical structure
• Extent of resection
• Number of resections
• Laterality
• Additional procedures
• Conversion of approach

The same diagnosis can result in very different procedure coding depending on what the surgeon actually performs.

VATS vs Open Thoracic Surgery Coding

One of the first coding questions should be:

Was the definitive procedure completed thoracoscopically or through an open approach?

Current CPT includes separate code families for many open and VATS lung resections.

Examples include:

Procedure	Open Example	VATS Example
Initial Therapeutic Wedge Resection	32505	32666
Additional Ipsilateral Therapeutic Wedge	+32506	+32667
Diagnostic Wedge Followed by Anatomical Resection	+32507	+32668
Segmentectomy	32484	32669
Single-Lobe Lobectomy	32480	32663
Bilobectomy	32482	32670
Pneumonectomy	32440	32671

When VATS Converts to Open Surgery

A thoracic procedure may begin through VATS and later convert to thoracotomy.

CMS’s 2026 NCCI guidance states that when a surgical thoracoscopy converts to an open thoracic procedure, the thoracoscopic procedure is not separately reported with the completed open procedure. A diagnostic thoracoscopy should not simply be substituted and reported with the open procedure either.

The operative report should document:

• Initial VATS approach
• Reason for conversion
• Point at which conversion occurred
• Open operation completed
• Extent of final resection

Common reasons may include:

• Bleeding
• Dense adhesions
• Difficult anatomy
• Tumor involvement
• Inability to safely complete the surgery thoracoscopically

The final claim should reflect the completed surgical service under the applicable coding rules.

Diagnostic Thoracoscopy With Surgical Thoracoscopy

CMS also states that diagnostic thoracoscopy codes are not separately reportable with a surgical thoracoscopy on the same side.

Diagnostic inspection is generally considered part of performing the more definitive thoracoscopic procedure.

This is an important denial-prevention point.

The presence of diagnostic inspection in the operative report does not automatically create an additional procedure line.

Wedge Resection Billing

Wedge resection removes a non-anatomical portion of the lung.

Thoracic surgeons may perform wedge resections for either diagnostic or therapeutic purposes.

The coding team should determine:

• Why the tissue was removed
• Whether the wedge was diagnostic or therapeutic
• Open vs VATS approach
• Number of resections
• Whether resections were ipsilateral
• Whether a larger anatomical resection followed

Therapeutic Wedge Resection

For an initial therapeutic open wedge resection, CPT 32505 is one example.

For VATS, CPT 32666 represents the initial unilateral therapeutic wedge resection.

Additional ipsilateral therapeutic wedges may involve the applicable add-on code when current CPT requirements are met.

For example:

• +32506 for qualifying additional open wedge resections
• +32667 for qualifying additional thoracoscopic wedge resections

Current CPT sources specifically identify these as additional-resection codes rather than separate primary procedures.

Multiple Wedge Resections

Documentation should identify each lesion and anatomical location.

For example, the note should distinguish:

• Right upper-lobe lesion
• Right lower-lobe lesion
• Two separate wedges from the same lobe
• Contralateral procedure when applicable

The billing team should not automatically multiply units merely because the surgeon used the stapler several times.

The number of reportable resections should be supported by distinct therapeutic resections documented in the operative note and the requirements of the applicable code family.

Diagnostic Wedge Followed by Anatomical Lung Resection

A common thoracic oncology scenario involves removing a pulmonary nodule for diagnostic evaluation before proceeding to a larger anatomical resection.

Current CPT contains specific add-on coding pathways for qualifying diagnostic wedge resections followed by anatomical lung resection:

• +32507 for the open approach
• +32668 for the thoracoscopic approach

For example, a patient may undergo a VATS diagnostic wedge, receive an intraoperative pathologic result, and then proceed to a VATS lobectomy.

In qualifying circumstances, +32668 is designed to represent the diagnostic wedge performed before the anatomical resection.

However, this should not be confused with separately coding every biopsy performed during a larger lung operation.

The relationship between the biopsy site and the definitive resection remains critical.

Segmentectomy Billing

A segmentectomy removes an anatomical bronchopulmonary segment rather than a non-anatomical wedge or an entire lobe.

Common examples include:

• Open segmentectomy: 32484
• Thoracoscopic segmentectomy: 32669

Current CPT references identify 32484 for an open segmental resection and 32669 for the thoracoscopic counterpart.

Documentation should clearly identify:

• Side
• Lobe
• Segment
• Surgical approach
• Vascular and bronchial division
• Lymph-node work when performed
• Additional resections

Using the word “partial lung resection” without identifying the anatomical segment can create unnecessary coding uncertainty.

Segmentectomy vs Wedge Resection

These procedures should not be treated as interchangeable.

A wedge resection removes a non-anatomical portion of lung.

A segmentectomy removes a defined anatomical pulmonary segment.

That difference affects coding and may significantly affect reimbursement.

The operative report should make the distinction clear.

Lobectomy Billing

A lobectomy removes an entire pulmonary lobe.

Common examples include:

• 32480 for an open single-lobe resection
• 32663 for a thoracoscopic single-lobe resection

Current CPT references identify these separately based on surgical approach.

The procedure report should identify:

• Right or left side
• Lobe removed
• Approach
• Pulmonary vessels divided
• Bronchus divided
• Additional wedge or segmental procedures
• Lymph-node work
• Conversion to open surgery when applicable

Do Not Code Lobectomy From the Diagnosis Alone

A lung cancer diagnosis does not determine the surgical code.

A patient with lung cancer may undergo:

• Wedge resection
• Segmentectomy
• Lobectomy
• Bilobectomy
• Pneumonectomy

Code selection should reflect the procedure actually documented.

Bilobectomy Billing

A bilobectomy removes two lobes of the right lung.

Current CPT examples include:

• 32482 for an open bilobectomy
• 32670 for thoracoscopic bilobectomy

Because the left lung contains only two lobes, bilobectomy terminology is generally associated with right-sided surgery.

The operative report should identify the exact lobes removed rather than merely state that a “major lung resection” was performed.

Pneumonectomy Billing

Pneumonectomy involves removal of an entire lung.

Examples include:

• 32440 for an open pneumonectomy
• 32671 for thoracoscopic pneumonectomy

More specialized open pneumonectomy codes may apply when additional work such as sleeve resection or extrapleural surgery is performed.

The coder should therefore review the complete operative report rather than automatically assign the basic pneumonectomy code.

CMS also notes that procedures describing removal of all lung tissue from a thoracic cavity already include certain work performed on the lung before removal, including thoracotomy exploration and several related intrathoracic services.

Lung Biopsy Bundling With Larger Resections

This is one of the most important NCCI issues in Thoracic Surgery Billing.

CMS’s 2026 guidance states that a diagnostic lung biopsy from an anatomical location that is subsequently removed during a more extensive procedure is not separately reportable with that procedure.

This applies to procedures such as:

• Segmentectomy
• Lobectomy
• VATS lobectomy
• Other larger lung resections

The rule applies whether the biopsy is examined:

• Intraoperatively
• After surgery

and whether the biopsy is performed to:

• Establish the diagnosis
• Determine whether larger surgery should proceed
• Determine the extent of surgery

When a Separate Lung Biopsy May Be Supported

CMS makes an important distinction when the biopsy comes from a different anatomical location that is not included in the larger resection.

In that situation, the biopsy may be separately reportable when the coding requirements are met.

This is why documentation should identify exact biopsy locations.

Compare these two situations:

Situation A: A wedge biopsy is obtained from the right upper lobe, and the entire right upper lobe is subsequently removed.

The biopsy site is part of the tissue removed by the larger operation.

Situation B: A biopsy is taken from a separate pulmonary location that is not included in the definitive resection.

That may require a different coding analysis.

The billing team should not decide based only on the fact that “a biopsy was performed.”

Bronchoscopy With Thoracic Surgery

Bronchoscopy is another frequent source of bundling errors.

A surgeon may perform bronchoscopy:

• To diagnose a lesion
• To inspect the airway
• To localize disease
• To assess anatomy before surgery
• To confirm the completed operation
• To investigate another airway problem

The clinical reason determines whether separate reporting may be appropriate.

Bronchoscopy Used Only for Surgical Assessment

CMS’s 2026 NCCI guidance states that an endoscopic procedure performed simply to evaluate the surgical field, confirm anatomy, assess disease extent, or verify the completed open procedure is not separately reportable with that operation.

For example, a routine bronchoscopy performed only to inspect the airway immediately before a pulmonary operation should not automatically generate an additional bronchoscopy charge.

Initial Diagnostic Bronchoscopy

A genuinely diagnostic bronchoscopy may follow a different pathway.

CMS gives an example where an initial diagnostic bronchoscopy identifies disease that leads to an open thoracic operation. Under the applicable circumstances, the diagnostic bronchoscopy may be separately reportable, while a later confirmatory bronchoscopy performed merely to plan the surgical approach is not.

Documentation should clearly establish:

• Diagnostic indication
• Findings
• Whether a previous adequate bronchoscopy existed
• Whether findings affected the treatment decision
• Relationship to subsequent surgery

Diagnostic vs Surgical Bronchoscopy

When a surgical bronchoscopy is performed, a diagnostic bronchoscopy is generally included.

The practice should report the most comprehensive procedure supported by the documentation rather than separately billing the diagnostic component simply because inspection occurred first.

Thoracotomy and Exploration Billing

Open thoracic procedures inherently require entry into and exploration of the chest.

CMS states that thoracotomy with exploration, CPT 32100, should not generally be separately reported simply to describe the approach used for another open thoracic procedure.

There are specific exceptions described by CMS, including situations involving:

• Contralateral thoracic surgery
• A separate ipsilateral incision
• Biopsy at a different anatomical site

These circumstances need clear documentation.

The billing team should not routinely add an exploratory thoracotomy code to every open lung resection.

Chest Tube Billing With Thoracic Surgery

Chest tubes are common after thoracic procedures.

However, routine placement does not necessarily support another payable procedure.

CMS states that tube thoracostomy 32551 is generally not separately reportable when performed during another open procedure in the same thoracic cavity.

This means a chest tube placed at the end of a lobectomy for expected postoperative drainage should not automatically be added as another procedure.

Contralateral Chest Tube

CMS identifies an exception when the tube thoracostomy is performed in the thoracic cavity opposite the one entered for the open thoracic operation.

The record should clearly identify laterality and the separate clinical reason.

Post-Procedure Chest X-Ray

A chest radiograph commonly follows:

• Thoracentesis
• Pleural drainage
• Chest tube insertion

CMS states that a chest radiograph performed merely to confirm the adequacy of the procedure, identify complications, or verify tube position should not be separately reported for that purpose.

This is another example where clinically necessary work may still be included within the procedural payment.

Pleurodesis Billing

Pleurodesis intentionally causes the pleural layers to adhere.

It may be performed for:

• Recurrent pneumothorax
• Recurrent pleural effusion
• Malignant pleural disease

For thoracoscopic pleurodesis, CPT 32650 is one commonly relevant code.

Documentation should identify:

• Side
• Indication
• Thoracoscopic approach
• Mechanical or chemical technique
• Other pleural procedures
• Additional pulmonary procedures

The coding team should review whether pleurodesis is separately reportable when performed with another thoracic operation rather than assuming that every documented pleural maneuver creates another claim line.

Decortication Billing

Decortication removes restrictive fibrous tissue from the lung or pleural surface.

It may be used in conditions such as:

• Empyema
• Trapped lung
• Fibrothorax

Thoracoscopic examples include:

• 32651 for qualifying partial pulmonary decortication
• 32652 for qualifying total pulmonary decortication

The operative report should establish the extent of the procedure.

Documentation such as:

“Adhesions taken down”

does not necessarily establish that a formal decortication was performed.

A stronger report should describe:

• Pleural peel
• Extent of removal
• Lung release
• Areas treated
• Resulting re-expansion when relevant

Other Thoracoscopic Pleural Procedures

The VATS code family also includes procedures for:

• Removal of fibrin or foreign material
• Bleeding control
• Bullae resection
• Pleurectomy
• Other pleural and pulmonary services

Current CPT references include thoracoscopic codes 32650–32656 for several of these services.

The billing team should select the procedure that most accurately describes the documented work rather than stack multiple component codes without reviewing bundling.

Mediastinal Procedure Billing

Thoracic surgery also includes procedures involving the mediastinum.

Current CPT contains distinct categories for:

• Mediastinal exploration
• Mass or tumor excision
• Mediastinoscopy
• Lymph-node sampling
• Thoracoscopic mediastinal procedures

STS treats mediastinal, pericardial, thymectomy, and diaphragmatic procedures as separate major coding topics within its general thoracic curriculum.

Mediastinoscopy

Current CPT includes:

• 39401 for diagnostic mediastinoscopy that may include biopsy when performed
• 39402 for mediastinoscopy involving lymph-node removal

Documentation should distinguish whether the surgeon:

• Inspected the mediastinum
• Obtained tissue samples
• Removed lymph nodes
• Performed a more extensive mediastinal operation

Mediastinal Mass Excision

Open excision of mediastinal tumors follows a different procedure family from mediastinoscopy.

For example, CPT 39220 represents a thoracic or sternal approach to excision of a mediastinal tumor.

This demonstrates why the term “mediastinal surgery” is not specific enough for final coding.

Thoracic Lymph-Node Procedures

Lymph-node evaluation is especially important in lung cancer surgery.

Procedures may include:

• Sampling
• Regional lymphadenectomy
• Mediastinal lymphadenectomy

The operative note should identify the work actually performed.

For thoracoscopic mediastinal and regional lymphadenectomy, CPT 32674 is one relevant procedure code.

Open thoracic or mediastinal lymphadenectomy may involve add-on CPT 38746 when current coding requirements are met.

Sampling vs Lymphadenectomy

Removing one or two lymph nodes for diagnostic evaluation is not necessarily equivalent to a formal lymphadenectomy.

The operative report should describe:

• Node stations
• Extent of dissection
• Nodes removed
• Relationship to the primary lung procedure

This allows the coder to determine whether the documentation supports a separately reportable lymph-node service.

Esophageal Surgery Billing

Esophageal procedures should not be treated as a small extension of pulmonary coding.

STS’s 2026 coding program gives esophageal surgery its own curriculum covering:

• Endoscopic procedures
• Esophageal resections
• Hiatal hernia procedures
• Other esophageal operations

Esophagectomy coding can depend on:

• Portion of esophagus removed
• Thoracic, abdominal, or combined approach
• Reconstruction method
• Gastric involvement
• Cervical anastomosis
• Minimally invasive vs open technique

Open Esophagectomy

Examples from the current CPT family include:

• 43112 for certain total or near-total esophagectomy procedures involving thoracotomy
• 43117 for an open partial distal esophagectomy using thoracic and abdominal incisions
• 43118 when a similar resection includes intestinal reconstruction instead of standard gastric reconstruction
• 43122 and 43123 for other partial esophagectomy approaches and reconstruction patterns

Current CPT references distinguish these procedures according to both the extent of resection and reconstruction technique.

Minimally Invasive Esophagectomy

Current coding also includes minimally invasive procedure pathways such as:

• 43287 for a qualifying laparoscopic/thoracoscopic Ivor Lewis-type esophagectomy
• 43288 for a qualifying thoracoscopic/laparoscopic/cervical McKeown-type procedure

This makes operative documentation particularly important.

The billing team needs to understand the entire reconstruction, not simply that “esophagectomy” was performed.

Robotic-Assisted Thoracic Surgery Billing

Robotic technology may assist VATS and other minimally invasive thoracic operations.

However, the use of a robot does not automatically create another payable physician CPT service.

Current thoracic reimbursement guidance notes that physician coding should use the CPT code describing the underlying laparoscopic or endoscopic operation. HCPCS S2900 may be recognized by some commercial payers for robotic assistance, but Medicare does not recognize it for separate payment.

This means a robotic-assisted lobectomy should still be coded based on the actual lobectomy and applicable approach.

The billing team should not create an additional robotic charge unless a payer-specific rule legitimately requires reporting.

Robotic Surgery and Modifier 22

Robotic technology alone does not justify modifier 22.

Modifier 22 should be considered only when documentation demonstrates substantially greater work than typically required by the primary procedure.

STS similarly notes that increased procedural work, such as unusually complex reoperative thoracic surgery, may sometimes support modifier 22 when the operative report documents the additional time, work, and complexity.

Thoracic Surgery Modifiers

Modifiers are important in Thoracic Surgery Billing because they explain circumstances that change how a procedure or E/M service should be processed.

Commonly relevant modifiers can include:

• 22
• 24
• 25
• 57
• 58
• 59
• 62
• 78
• 79
• 80
• 81
• 82
• AS
• RT/LT where applicable
• X modifiers when appropriate

A modifier should never be appended simply to bypass an NCCI edit.

CMS specifically states that modifiers may override an edit only when the clinical circumstances actually justify their use.

Modifier 22

Modifier 22 identifies increased procedural services.

It may be considered when an operation requires significantly greater work because of circumstances such as:

• Severe adhesions
• Difficult reoperative anatomy
• Unusually complex dissection
• Other significant additional work

The operative report should document:

• What made the procedure unusually difficult
• Additional work performed
• Additional time when relevant
• How the case differed from a typical procedure

Modifier 57

Modifier 57 identifies the E/M service where the decision for major surgery is made.

CMS states that the initial evaluation resulting in the decision for a major surgical procedure may be separately payable with modifier 57 rather than being included in the global package.

This may be relevant when a thoracic surgeon evaluates a patient and decides that major surgery is required.

Modifier 58

Modifier 58 applies to qualifying staged or related procedures during the postoperative period.

Examples may include a procedure that is:

• Planned prospectively
• More extensive than the original procedure
• Therapeutic after a diagnostic procedure

CMS also specifically references modifier 58 in its thoracoscopy and bronchoscopy guidance when diagnostic findings lead to an open procedure under qualifying circumstances.

A new global period generally begins with the procedure reported using modifier 58 under Medicare’s global surgery rules.

Modifier 78

Modifier 78 applies to an unplanned return to the operating room for a related procedure during the postoperative period.

Examples in thoracic surgery might involve a patient returning to the OR for a postoperative complication requiring operative treatment.

Routine management of a complication that does not require return to the operating room may remain included in the global package under Medicare rules.

Modifier 79

Modifier 79 identifies a procedure performed during the global period that is unrelated to the original surgery.

The unrelated nature of the second procedure should be clearly documented.

Modifier 59 and X Modifiers

Modifier 59 or one of the more specific X modifiers may sometimes identify distinct procedural circumstances.

They should not be added solely because two codes encounter an NCCI edit.

Documentation needs to establish why the services are truly distinct, such as a separate:

• Anatomical site
• Encounter
• Practitioner where applicable
• Non-overlapping service

CMS specifically warns against using modifiers solely to force payment through an NCCI edit.

Global Surgical Periods in Thoracic Surgery

Global surgery rules are particularly important because major thoracic procedures often involve substantial postoperative care.

Medicare classifies surgical procedures into global categories such as:

• 0-day
• 10-day
• 90-day
• Other indicators such as ZZZ, YYY, or XXX

CMS states that many major surgeries carry a 90-day postoperative period, while the exact global indicator for a specific procedure should be verified using the Medicare Physician Fee Schedule.

The billing team should therefore verify the actual global indicator rather than assuming every thoracic code follows the same rule.

Services Commonly Included in the Global Package

Under Medicare rules, the global surgical payment generally includes:

• Routine postoperative visits
• Normal recovery management
• Incision care
• Dressing changes
• Removal of routine drains, tubes, sutures, and staples
• Treatment of complications that do not require another trip to the operating room

This is particularly relevant in thoracic surgery, where postoperative visits may involve:

• Chest tube management
• Incision assessment
• Recovery monitoring
• Routine postoperative imaging review
• Expected pain management

The team should determine whether the service represents normal postoperative care or a separately reportable service.

NCCI Bundling in Thoracic Surgery

NCCI review should occur before complex thoracic claims are submitted.

Several clinical services may be described individually in an operative report even though they are included in the main procedure.

Important examples include:

• Diagnostic thoracoscopy with surgical thoracoscopy
• Surgical thoracoscopy converted to open surgery
• Thoracotomy exploration with another open thoracic operation
• Lung biopsy from tissue subsequently removed
• Routine chest tube placement with open thoracic surgery
• Bronchoscopy used only to assess the surgical field
• Confirmatory imaging after pleural drainage

CMS’s 2026 NCCI manual addresses each of these areas specifically.

The coding principle is straightforward:

The operative report may describe many clinical steps, but the claim should represent the services that are independently reportable under current coding rules.

Common Thoracic Surgery Claim Denials

Denial Reason	Why It Happens	Prevention Strategy
Incorrect VATS or Open Code	The claim reflects the scheduled approach rather than the procedure ultimately completed.	Code from the final operative report and clearly identify conversions.
Incorrect Lung Resection	Wedge, segmentectomy, lobectomy, bilobectomy, or pneumonectomy is selected incorrectly.	Verify the exact amount and anatomical portion of lung removed.
Diagnostic Wedge Error	A diagnostic wedge is reported incorrectly when followed by a larger anatomical resection.	Review whether the applicable diagnostic-wedge add-on pathway is supported.
Lung Biopsy Bundling	A biopsy is separately reported even though the biopsied tissue was included in the definitive resection.	Confirm the exact anatomical biopsy site and relationship to the larger operation.
Bronchoscopy Bundling	A routine or confirmatory bronchoscopy is reported separately from the surgical procedure.	Determine whether the bronchoscopy was independently diagnostic or merely part of surgical assessment.
Diagnostic Thoracoscopy Bundling	Diagnostic thoracoscopy is billed with a more comprehensive ipsilateral surgical thoracoscopy.	Apply NCCI endoscopy rules and report the most comprehensive supported service.
Chest Tube Bundling	Routine tube thoracostomy is billed separately during an open operation in the same thoracic cavity.	Review whether the chest tube is integral to the main procedure or qualifies under a separate circumstance.
Global Period Denial	Routine postoperative care is billed separately without meeting an exception to the global package.	Verify the procedure’s global indicator and use modifiers only when supported.
Authorization Mismatch	The final operation differs from the service originally authorized.	Compare the authorization with the completed surgery before claim submission.
Incomplete Operative Note	The record does not clearly establish approach, side, extent of resection, or additional procedures.	Complete documentation review and obtain clarification before final coding.

How Thoracic Surgery Practices Can Prevent Claim Denials

1. Code From the Final Operative Report

Do not rely on:

• Surgical schedule
• Authorization description
• Preoperative plan
• Procedure preference card

These describe what was expected.

The claim should describe what was actually performed.

2. Confirm the Surgical Approach

Determine whether the final operation was:

• Open
• VATS
• Robotic-assisted thoracoscopic
• Converted from minimally invasive to open

Conversion should be clearly documented.

3. Identify the Exact Lung Resection

Before assigning a pulmonary resection code, determine whether the surgeon performed:

• Wedge resection
• Segmentectomy
• Lobectomy
• Bilobectomy
• Pneumonectomy

Do not infer the extent of resection from the diagnosis.

4. Review Every Lung Biopsy Against the Final Resection

Ask whether the biopsy site was:

• Included in the subsequently removed tissue
• Located elsewhere

This distinction can determine whether separate reporting is supported.

5. Review Bronchoscopy Before Billing It Separately

Determine whether the bronchoscopy was:

• Independently diagnostic
• Therapeutic
• Routine preoperative inspection
• Confirmatory after surgery

Not every bronchoscopy performed in the operating room supports a separate claim.

6. Review Thoracoscopy Bundling

Diagnostic thoracoscopy is generally included in a more comprehensive ipsilateral surgical thoracoscopy.

If VATS converts to an open procedure, review the conversion rules before reporting either thoracoscopy code.

7. Review Pleural and Chest Tube Services

Confirm whether services such as:

• Thoracostomy
• Pleural drainage
• Pleurodesis
• Decortication

are separately reportable or already included in a larger thoracic operation.

8. Review Lymph-Node Documentation

The note should identify:

• Node stations
• Extent of dissection
• Sampling vs lymphadenectomy
• Surgical approach

This is especially important in oncologic lung surgery.

9. Verify the Global Period

Before billing postoperative services, confirm:

• Global indicator
• Relationship to original surgery
• Whether a return to the OR occurred
• Whether the service was staged
• Whether the service was unrelated

Then select the modifier only when documentation supports it.

10. Compare Authorization With the Final Operation

A planned wedge resection may become a lobectomy.

A minimally invasive procedure may convert to open surgery.

The billing team should review whether the final service remains within payer authorization requirements.

Thoracic Surgery Denial Prevention Checklist

Area	Review Question
Final Procedure	Does the claim reflect the surgery actually completed rather than the original surgical plan?
Approach	Was the procedure open, thoracoscopic, robotic-assisted, or converted to open?
Laterality	Is the correct right or left side documented where required?
Lung Resection	Does the documentation distinguish wedge, segmentectomy, lobectomy, bilobectomy, and pneumonectomy?
Multiple Wedges	Are additional resections distinct and supported by the applicable add-on coding rules?
Diagnostic Wedge	Was a diagnostic wedge followed by an anatomical lung resection, and is the appropriate add-on pathway supported?
Lung Biopsy	Was the biopsy site included in the tissue subsequently removed?
Bronchoscopy	Was the bronchoscopy independently diagnostic or merely part of surgical assessment?
Thoracoscopy	Has diagnostic thoracoscopy been correctly bundled with a more comprehensive procedure when required?
Chest Tube	Is the thoracostomy separately reportable or integral to another open thoracic procedure?
Lymph Nodes	Does the operative report clearly distinguish sampling from formal lymphadenectomy?
Esophageal Procedure	Are the approach, extent of resection, and reconstruction clearly documented?
Global Period	Has the correct global indicator been verified before postoperative services are billed?
Modifier	Does the clinical documentation support every modifier appended to the claim?
Authorization	Does the approved service align with the final surgical procedure?

Why Thoracic Surgery Requires Specialty Coding Expertise

Thoracic Surgery Billing requires the coding team to understand far more than a list of CPT codes.

A coder may need to interpret:

• Pulmonary anatomy
• Open vs VATS approach
• Anatomical vs non-anatomical lung resection
• Diagnostic vs therapeutic procedures
• Lung biopsy location
• Bronchoscopy purpose
• Pleural procedures
• Mediastinal surgery
• Lymph-node dissection
• Esophageal reconstruction
• Global surgery
• NCCI bundling

The most important question is not:

How many procedures are listed in the operative note?

It is:

Which procedures accurately represent the completed surgery under current coding and payer rules?

A strong Thoracic Surgery Billing process combines precise operative documentation, specialty coding review, authorization validation, NCCI analysis, and careful modifier selection before high-value surgical claims reach the payer.

How Thoracic Surgery Practices Can Improve Revenue Cycle Performance

Improving Thoracic Surgery Billing requires coordination from scheduling through final payment.

The strongest revenue cycle does not wait for a denial before identifying a problem.

It attempts to prevent problems at each stage of the claim.

1. Review High-Value Surgical Claims Before Submission

Major thoracic claims should receive additional review before they reach the payer.

Examples may include:

• Lobectomy
• Bilobectomy
• Pneumonectomy
• Segmentectomy
• Esophagectomy
• Major decortication
• Complex mediastinal procedures
• Extensive chest wall surgery

A pre-bill review should confirm:

• Final surgical approach
• Procedure performed
• Laterality
• Extent of lung resection
• Diagnosis
• Additional procedures
• NCCI bundling
• Modifiers
• Authorization
• Global-period implications

A preventable error on a high-value surgical claim can result in weeks or months of unnecessary follow-up.

2. Code From the Final Operative Report

Thoracic procedures may change significantly during surgery.

A planned VATS wedge resection could become:

• Segmentectomy
• Lobectomy
• Open thoracotomy
• Another more extensive procedure

Charge capture should therefore be based on the final operative report, not only the scheduled surgery.

The billing team should compare:

• Scheduled procedure
• Authorized procedure
• Completed procedure
• Final codes

This helps identify situations where authorization or charge capture needs additional review.

3. Create an Operative-Note Completion Workflow

Claims should not remain unbilled because important operative details are missing.

Practices can establish a workflow for identifying reports that lack information such as:

• Side
• Lobe
• Segment
• Extent of resection
• Open vs VATS approach
• Conversion to open surgery
• Lymph-node procedure
• Biopsy location
• Additional procedures

Coding queries should be sent quickly when clarification is required.

Tracking repeated documentation problems can also help identify opportunities for physician education.

4. Strengthen Prior Authorization Controls

Authorization should be reviewed both before and after surgery.

Before surgery, staff may confirm:

• Payer
• Procedure
• Diagnosis
• Surgeon
• Facility
• Effective dates
• Medical necessity requirements

After surgery, billing staff should compare the approval with what was actually performed.

This is especially important when:

• VATS converts to open surgery
• A wedge becomes a lobectomy
• Additional procedures are performed
• The surgical approach changes
• The extent of resection changes

The practice should understand the payer’s requirements for changed or additional procedures before submitting the claim.

5. Separate Surgical AR From Routine Office AR

Thoracic surgery practices should not rely only on one overall AR report.

Major surgical claims should be visible separately from:

• Office visits
• Routine follow-ups
• Diagnostic services
• Other lower-value encounters

This allows the practice to identify whether substantial revenue is sitting unpaid.

Useful surgical AR categories may include:

• Lung resections
• VATS procedures
• Pleural procedures
• Mediastinal surgery
• Esophageal procedures
• Bronchoscopy
• Other thoracic surgery

This type of reporting makes financial problems easier to investigate.

6. Track Denials by Procedure Type

A general denial rate may not explain where the problem exists.

Thoracic practices should categorize denials based on areas such as:

• VATS vs open coding
• Lung resection
• Diagnostic biopsy
• Bronchoscopy
• Pleural procedures
• Lymph-node procedures
• Global period
• Authorization
• Medical necessity
• Modifier use

For example, repeated bronchoscopy denials may indicate that services are being reported separately when they are actually integral to surgery.

Repeated authorization denials may indicate that staff are not comparing approved services with the final operation.

The purpose of denial analysis should be to change the workflow that caused the problem.

High-Value Thoracic Surgery Claim Management

Major surgical claims should receive more attention than routine claims.

Practices can create a high-value claim work queue that identifies accounts requiring closer monitoring.

What Should a High-Value Claim Review Include?

The review may include:

• Procedure code
• Diagnosis
• Operative report
• Authorization
• Additional procedures
• Modifiers
• Bundling
• Expected reimbursement
• Claim submission status

This review can occur before submission and continue until payment is received.

Monitor Claims Soon After Submission

A high-value claim should not wait until it reaches 60 or 90 days in AR before someone checks its status.

Early follow-up can identify:

• Claim rejection
• Missing information
• Medical record request
• Authorization issue
• Coding review
• Payer processing delay

The earlier a problem is identified, the more quickly the practice can respond.

Respond Promptly to Medical Record Requests

Major surgical claims frequently require supporting documentation.

Requested records may include:

• Operative report
• Pathology
• Imaging
• Authorization
• Office notes
• Clinical history
• Medical necessity documentation

Practices should have a clear process for sending requested records and tracking payer receipt.

Critical Care Billing in Thoracic Surgery

Thoracic surgeons may manage patients with serious postoperative or acute conditions requiring critical care.

Examples can occur after:

• Extensive lung surgery
• Esophageal surgery
• Major complications
• Respiratory deterioration
• Hemodynamic instability
• Other life-threatening conditions

Critical care billing requires more than documenting that the patient was in the ICU.

The documentation should support that the patient’s condition met applicable critical-care requirements and that the physician personally provided qualifying critical-care services.

Critical Care vs Routine Postoperative Management

This distinction is particularly important during a surgical global period.

Routine postoperative management may already be included in the global surgical package.

A patient being:

• Monitored in ICU
• Seen after surgery
• Managed for expected postoperative pain
• Evaluated during normal recovery

does not automatically support separately billable critical care.

The clinical record must support the actual service being reported and its relationship to the original surgery.

Critical Care Documentation

When qualifying critical care is provided, documentation should clearly support:

• Critical condition
• Physician management
• Medical decision-making
• Time when required
• Relationship to the surgical procedure
• Services performed

Thoracic practices should review these encounters carefully before billing them separately during a global period.

E/M Billing for Thoracic Surgery Practices

Thoracic surgeons also provide significant evaluation and management services outside the operating room.

These may include:

• New patient consultations
• Surgical evaluations
• Cancer-related treatment planning
• Preoperative visits
• Postoperative management
• Surveillance
• Management of unrelated conditions

The billing team should understand when an E/M service is:

• Separately reportable
• Included in the global package
• Associated with the decision for surgery
• Unrelated to the original procedure

Decision for Major Surgery

A medically necessary E/M encounter in which the surgeon makes the decision to perform major surgery may require specific modifier consideration under applicable payer rules.

The documentation should clearly show:

• Patient evaluation
• Surgical decision
• Risks and treatment discussion
• Plan for surgery

Staff should not add modifiers automatically based only on the date of surgery.

E/M During the Global Period

When a patient is seen during the postoperative period, the practice should determine whether the encounter represents:

• Routine postoperative care
• Treatment of a related complication
• A staged surgical service
• An unrelated medical condition

This determines whether the service is part of the original surgical payment or may qualify for separate reporting.

Managing the Thoracic Surgery Global Period

Global-period management should involve both clinical and billing teams.

Practices should know:

• Procedure date
• Global indicator
• Global start and end dates
• Related postoperative visits
• Returns to the OR
• Staged procedures
• Unrelated services

A global-period tracking workflow can reduce both overbilling and missed reimbursement.

Routine Postoperative Visits

Routine follow-up may involve:

• Incision review
• Healing assessment
• Routine drain or tube management
• Expected postoperative symptoms
• Surgical recovery monitoring

When these services fall within the global package, they generally should not be billed as unrelated E/M encounters.

Staged or More Extensive Procedures

Some patients require another planned or progressively more extensive procedure during the postoperative period.

Billing staff should review whether the clinical circumstances support the appropriate staged-procedure modifier under applicable payer rules.

The operative record should clearly document why the subsequent procedure occurred.

Unplanned Return to the Operating Room

Postoperative complications may occasionally require an unexpected return to the OR.

Examples could involve:

• Bleeding
• Persistent air leak requiring operative treatment
• Infection
• Other surgical complications

The claim should accurately identify the relationship between the return procedure and the original surgery.

Unrelated Procedures

A patient may undergo an unrelated procedure during the global period.

The medical record should clearly show why the second service is unrelated to the original surgery before the appropriate modifier is used.

Professional and Facility Billing Coordination

Major thoracic procedures can generate separate claims from:

• Surgeon
• Assistant surgeon
• Hospital
• Anesthesia provider
• Pathology
• Radiology
• Other involved clinicians

These claims should reflect a consistent clinical story.

Why Coordination Matters

Payer review may become more difficult when the surgeon and facility submit significantly different information.

Potential mismatches include:

• Different procedure
• Different approach
• Different diagnosis
• Different laterality
• Missing conversion
• Different date information

Professional billing teams should coordinate with facility records when discrepancies appear.

Assistant Surgeon and Additional Provider Roles

Some complex thoracic procedures may involve:

• Assistant surgeons
• Co-surgeons
• Other qualified practitioners

The billing team should confirm:

• Provider role
• Procedure involvement
• Documentation
• Payer rules
• Applicable modifier

Provider role should not be assumed simply because another surgeon’s name appears in the operative record.

Reviewing Thoracic Surgery Payments for Underpayments

Payment posting should not stop at:

Claim paid.

The practice should also determine whether the claim was paid correctly.

Potential underpayment issues include:

• Incorrect contractual allowance
• Missing procedure payment
• Incorrect modifier processing
• Improper bundling
• Incorrect multiple-procedure reduction
• Payer fee schedule issue
• Incorrect assistant-surgeon payment

Compare Payment With Expected Reimbursement

Where possible, payment posting teams should compare:

• Amount billed
• Contracted or expected allowed amount
• Payment received
• Adjustment
• Patient responsibility

Significant discrepancies should be moved into an underpayment work queue.

Review High-Value Payments Individually

Underpayments can be particularly important for procedures such as:

• Lobectomy
• Pneumonectomy
• Esophagectomy
• Complex thoracic oncology surgery

Even a relatively small percentage difference can represent meaningful lost revenue on a high-value surgical claim.

Thoracic Surgery Revenue Cycle Metrics to Monitor

Practices should monitor metrics that show both claim accuracy and payment performance.

Useful measures may include:

• Clean claim rate
• First-pass payment rate
• Denial rate
• Authorization denial rate
• Coding denial rate
• Global-period denial rate
• Days in AR
• Surgical AR over 90 days
• High-value claim aging
• Underpayment volume
• Appeal success rate
• Unbilled operative reports
• Average time from surgery to claim submission
• Collections by procedure category

The goal is not simply to produce reports.

Metrics should help identify where revenue is getting delayed.

Thoracic Surgery Revenue Cycle Review

Revenue Cycle Area	What the Practice Should Monitor
Prior Authorization	Whether the approved procedure, surgeon, facility, and diagnosis match the final surgical service.
Operative Documentation	Whether approach, anatomy, extent of resection, additional procedures, and conversions are clearly documented.
Charge Capture	Whether the final charges represent the completed operation rather than only the scheduled procedure.
Coding Review	Whether lung resections, bronchoscopy, biopsies, pleural services, and modifiers have been reviewed for bundling.
Global Period	Whether postoperative services are correctly classified as included, staged, related, or unrelated.
High-Value Claims	Whether complex surgical claims receive additional pre-bill and post-submission review.
Denials	Whether recurring denial causes are analyzed by procedure type and payer.
Payments	Whether high-value surgical reimbursements match expected payment.
AR	Whether aging surgical balances are tracked separately from routine office accounts.

In-House vs Outsourced Thoracic Surgery Billing

Thoracic practices can manage billing internally or use an external billing and revenue-cycle team.

The appropriate model depends on:

• Surgical volume
• Procedure complexity
• Number of surgeons
• Locations
• Internal coding expertise
• Denial volume
• Staffing
• AR performance

Area	In-House Billing	Outsourced Thoracic Surgery Billing
Thoracic Coding	Internal staff must maintain expertise in VATS, open surgery, lung resections, bronchoscopy, pleural procedures, and esophageal surgery.	Specialty-focused billing resources can support coding review across complex thoracic procedure categories.
Operative Note Review	Internal coders identify missing approach, anatomy, resection, and additional procedure details.	A structured review process can identify documentation gaps before high-value claims are submitted.
Prior Authorization	Practice staff tracks approvals and procedure changes internally.	Authorization support can help compare approved services with the final operation.
NCCI Review	Internal staff must review lung biopsy, bronchoscopy, thoracoscopy, chest tubes, and other bundled services.	Specialty claim review can help identify bundled and legitimately separate services.
Global Periods	The practice tracks postoperative services, related procedures, and returns to the OR.	A defined global-period workflow can support appropriate modifier and postoperative claim review.
High-Value Claims	Internal staff must build and manage their own priority work queues.	Complex surgical claims can receive targeted pre-bill and AR follow-up.
Denial Management	The internal team researches and appeals coding, authorization, and medical necessity denials.	Denials can be categorized by procedure and root cause to identify recurring workflow problems.
Underpayments	The practice compares payments against contracts and expected reimbursement internally.	Payment review can help identify significant reimbursement variances and unresolved underpayments.
Staffing	The practice manages recruitment, training, coverage, and continuing education.	External billing resources can provide additional revenue-cycle capacity without maintaining the same internal staffing structure.

Benefits of Outsourcing Thoracic Surgery Billing

Outsourcing may be useful when a practice needs additional specialty knowledge or revenue-cycle capacity.

Access to Thoracic Surgery Coding Knowledge

Thoracic coding requires familiarity with:

• Pulmonary anatomy
• VATS
• Thoracotomy
• Wedge resection
• Segmentectomy
• Lobectomy
• Pneumonectomy
• Bronchoscopy
• Pleural procedures
• Mediastinal surgery
• Esophageal procedures
• Global surgery rules

Specialty knowledge becomes particularly valuable when multiple services occur during one operation.

Better High-Value Claim Oversight

Complex surgical claims can receive additional review before submission.

This may help identify:

• Coding inconsistencies
• Missing documentation
• Authorization mismatch
• Bundling issues
• Modifier problems

The objective is to reduce preventable delays before significant revenue becomes tied up in AR.

Stronger Denial Management

Denial follow-up should identify why the claim failed.

Recurring causes may include:

• VATS/open mismatch
• Biopsy bundling
• Bronchoscopy bundling
• Authorization
• Global surgery
• Documentation
• Modifier use

Addressing the root cause can help prevent similar denials on future claims.

More Consistent AR Follow-Up

Dedicated AR resources can prioritize:

• High-value claims
• Older surgical balances
• Denied procedures
• Medical record requests
• Underpayments

This can prevent complex claims from remaining unresolved simply because routine claims consume staff time.

Reduced Administrative Pressure

Thoracic practices already manage:

• Surgical scheduling
• Clinical coordination
• Cancer care
• Postoperative management
• Hospital communication
• Authorization

Additional revenue-cycle support can reduce the amount of clinical and administrative time spent on:

• Claim corrections
• Denials
• Payer follow-up
• Appeals
• Payment investigation

When Should a Thoracic Surgery Practice Consider Outsourcing Billing?

Outsourcing may be worth evaluating when a practice experiences:

• Growing surgical AR
• Frequent coding denials
• Authorization problems
• High-value claims aging without resolution
• Difficulty interpreting complex operative reports
• Global-period billing errors
• Underpayments
• Limited reporting
• Staff turnover
• Backlogs in claim submission

The decision should be based on the performance of the current revenue cycle.

A practice may have a busy billing team and still perform well.

Another practice may have adequate staffing but lack the specialty expertise needed for complex thoracic claims.

How to Choose a Thoracic Surgery Billing Partner

A billing partner should understand the procedures and financial risks specific to thoracic surgery.

1. Do They Understand VATS and Open Thoracic Procedures?

Ask whether the team can distinguish:

• Thoracoscopic procedures
• Open procedures
• Conversion to open surgery
• Robotic-assisted approaches

The coder should not depend only on the scheduled procedure.

2. Can They Differentiate Pulmonary Resections?

The team should understand the difference between:

• Wedge resection
• Segmentectomy
• Lobectomy
• Bilobectomy
• Pneumonectomy

This is one of the most fundamental thoracic coding requirements.

3. How Do They Review Lung Biopsies?

Ask how the team determines whether a lung biopsy is:

• Included in a larger resection
• From a separate anatomical site
• Reportable through an applicable diagnostic-wedge pathway

This is a common area of bundling risk.

4. How Do They Handle Bronchoscopy?

The billing team should distinguish:

• Independent diagnostic bronchoscopy
• Therapeutic bronchoscopy
• Routine surgical assessment
• Confirmatory bronchoscopy

Not every bronchoscopy during thoracic surgery should automatically become another claim line.

5. Can They Handle Pleural and Mediastinal Procedures?

Ask about coding experience with:

• Chest tubes
• Pleurodesis
• Decortication
• Mediastinoscopy
• Mediastinal surgery
• Lymph-node procedures

A thoracic billing partner should understand more than pulmonary resections.

6. Do They Understand Esophageal Surgery?

Thoracic practices that perform esophageal surgery need billing support familiar with:

• Esophagectomy
• Different approaches
• Extent of resection
• Reconstruction

These procedures should not be handled as generic general surgery claims.

7. How Do They Manage Global Periods?

Ask how the team tracks:

• Routine postoperative care
• Staged procedures
• Return to OR
• Unrelated procedures
• Modifier use

The practice should know how postoperative services are reviewed before billing.

8. How Are High-Value Claims Monitored?

Ask whether major surgical claims receive:

• Pre-bill review
• Early payer follow-up
• Medical-record monitoring
• Underpayment review
• Escalation when aging

Major thoracic claims should not be treated exactly like routine office claims.

9. What Reporting Will the Practice Receive?

Useful reporting may include:

• Surgical claims submitted
• Collections
• Denials
• Procedure-specific AR
• High-value claim status
• Underpayments
• Authorization problems
• Payer trends

The practice should be able to see where reimbursement is being delayed.

How Pro Medical Billing Solutions Supports Thoracic Surgery Practices

Thoracic surgery practices need a revenue cycle capable of managing complex surgical claims from preoperative verification through final payment.

Billing problems can begin with:

• Eligibility
• Prior authorization
• Operative documentation
• Coding
• NCCI bundling
• Global-period management
• Claim submission
• Payment posting
• Denials
• AR

Pro Medical Billing Solutions supports healthcare organizations across revenue-cycle functions such as:

• Medical billing
• Medical coding
• Insurance verification
• Prior authorization support
• Claim submission
• Payment posting
• Denial management
• Accounts receivable follow-up
• Revenue cycle management

For thoracic surgery practices, these workflows can place particular attention on:

• Complex operative reports
• VATS and open procedures
• High-value surgical claims
• Authorization
• Denial trends
• Underpayments
• Aging surgical AR

The objective is to help the practice maintain clearer control over revenue from the time surgery is scheduled through final claim resolution.

Frequently Asked Questions

What is Thoracic Surgery Billing?

Thoracic Surgery Billing is the process of documenting, coding, submitting, and managing claims for surgical and related services involving structures such as:

• Lungs
• Pleura
• Mediastinum
• Esophagus
• Chest wall
• Diaphragm

It includes both minimally invasive and open thoracic procedures.

Why is thoracic surgery billing complex?

Thoracic claims may depend on:

• Surgical approach
• Extent of lung resection
• Anatomical location
• Diagnostic vs therapeutic intent
• Bundling
• Global periods
• Modifiers
• Prior authorization

Several procedures may also occur during the same operative encounter.

How does VATS affect thoracic surgery billing?

VATS procedures often have different coding pathways from comparable open procedures.

The billing team should determine whether surgery was completed thoracoscopically or converted to an open approach.

The final operative report should drive code selection.

What is the difference between a wedge resection and segmentectomy?

A wedge resection removes a non-anatomical portion of lung tissue.

A segmentectomy removes a defined anatomical bronchopulmonary segment.

Because these are different surgical procedures, accurate operative documentation is necessary for correct coding.

How is lobectomy different from pneumonectomy for billing purposes?

A lobectomy removes one pulmonary lobe, while a pneumonectomy removes an entire lung.

The coding also depends on whether the surgery was performed through an open or thoracoscopic approach.

Can a lung biopsy be billed with a lobectomy?

Not always.

When the biopsy involves tissue subsequently removed during the larger resection, separate reporting may not be appropriate.

A biopsy from a distinct anatomical location not included in the larger resection may require a different coding analysis.

Can bronchoscopy be billed separately with thoracic surgery?

Sometimes.

A genuinely diagnostic or separately reportable bronchoscopy may qualify under applicable rules.

A bronchoscopy performed only to inspect anatomy or assess the surgical field may be included in the larger thoracic procedure.

Is chest tube placement separately billable after thoracic surgery?

Routine chest tube placement performed as part of another thoracic operation may be included in that procedure.

Separate reporting depends on the clinical circumstances and applicable coding rules.

How does robotic thoracic surgery affect billing?

Robotic assistance does not automatically create a separate physician procedure code.

The claim should represent the actual thoracic operation performed and the applicable surgical approach.

Why are thoracic surgery claims commonly denied?

Common reasons include:

• Incorrect VATS/open coding
• Wrong lung resection code
• Lung biopsy bundling
• Bronchoscopy bundling
• Authorization mismatch
• Global-period errors
• Modifier problems
• Incomplete operative documentation

How can thoracic surgery practices reduce denials?

Practices can reduce preventable denials by:

• Coding from the final operative report
• Verifying the final surgical approach
• Reviewing anatomy and extent of resection
• Checking NCCI bundling
• Matching authorization to the final operation
• Managing global periods carefully
• Reviewing high-value claims before submission

Should thoracic surgery practices outsource billing?

Outsourcing may be useful when the practice faces:

• Complex coding
• Growing surgical AR
• Authorization workload
• Frequent denials
• Global-period challenges
• Underpayments
• Staffing limitations

The decision should depend on surgical volume, internal expertise, staffing resources, and revenue-cycle performance.

Final Thoughts: Building a Stronger Thoracic Surgery Revenue Cycle

Thoracic Surgery Billing requires detailed coordination between clinical documentation and financial operations.

The practice may manage procedures involving:

• VATS
• Thoracotomy
• Wedge resection
• Segmentectomy
• Lobectomy
• Pneumonectomy
• Bronchoscopy
• Pleural surgery
• Mediastinal procedures
• Esophageal surgery

Each service can involve different coding, authorization, bundling, and postoperative requirements.

The strongest billing workflow starts before surgery with accurate insurance verification and authorization.

After the operation, the final operative report should establish:

• Procedure performed
• Surgical approach
• Anatomy
• Extent of resection
• Additional services
• Conversion when applicable

The claim should then undergo appropriate coding, NCCI, modifier, and global-period review before submission.

Once the claim reaches the payer, the practice still needs to monitor:

• Processing
• Medical record requests
• Denials
• Payments
• Underpayments
• Aging AR

A well-structured Thoracic Surgery Billing process can help practices:

• Improve charge capture
• Reduce preventable coding errors
• Strengthen authorization management
• Improve high-value claim oversight
• Reduce avoidable denials
• Identify underpayments
• Improve surgical AR follow-up
• Gain clearer financial visibility

For thoracic surgery practices, the goal is not simply to submit a claim after the operation.

The goal is to accurately translate a complex surgical encounter into a defensible claim and manage that claim through appropriate reimbursement.