In the intricate world of healthcare billing, thoracic surgery stands out for its complex procedures and equally complex coding. Whether it’s lung resections, mediastinal tumor removal, or esophageal interventions, one billing mistake can cost providers thousands in denied claims. But what if you had a blueprint to navigate thoracic surgery billing in 2025 with precision and confidence?
That’s exactly what this blog offers: a clear, digestible, and up-to-date guide to mastering thoracic surgery billing, including CPT/ICD coding changes, documentation tips, and 2025 reimbursement updates that directly affect your revenue cycle.
Understanding the Backbone: Billing and Coding Guidelines for Thoracic Surgery
Billing for thoracic surgery is built around procedural accuracy and diagnostic specificity. In 2025, CMS (Centers for Medicare & Medicaid Services) and most private insurers have doubled down on compliance, so following the correct sequence of CPT and ICD-10-CM codes is critical.
Key Guidelines:
| Guideline Area | Description |
| Documentation | Operative reports must clearly describe the surgical technique, laterality, extent of resection, and any complications. |
| Bundling vs Unbundling | Watch out for procedures that are bundled. For instance, thoracotomy (CPT 32100) is bundled with most open lung resections. |
| Global Periods | Most major thoracic surgeries carry a 90-day global period – any related postoperative visits should not be billed separately. |
| Medical Necessity | The diagnosis must support the need for surgery. For example, a wedge resection must be justified by conditions like lung cancer (ICD-10 C34.91) |
CPT Codes Commonly Used in Thoracic Surgery (2025)
Here’s a snapshot of some of the most billed CPT codes in thoracic surgery. Many of these remained unchanged for 2025, but a few have adjusted relative value units (RVUs) and reimbursement rates.
| Procedure | CPT Code | Description | Global Period |
| Wedge Resection, Lung | 32505 | Biopsy or wedge resection of the lung, via thoracotomy | 90 days |
| Lobectomy | 32480 | Removal of the lobe of the lung, open | 90 days |
| Video- Assisted Thoracoscopic Surgery (VATS | 32666 | VATS with lobectomy | 90 days |
| Esophagectomy | 43117 | Removal of the esophagus, with a gastric pull-up | 90 days |
| Mediastinoscopy | 39401 | Mediastinal lymph node biopsy via cervical mediastinoscopy | 10 days |
| Pleurodesis | 32560 | Chemical pleurodesis for pleural effusion | 10 days |
2025 Update: Codes 32666 and 39401 received RVU adjustments due to CMS reevaluation, with slight reimbursement increases (~3.2%).
ICD-10-CM Codes That Support Thoracic Surgery
When choosing the right diagnosis code, specificity is everything. For 2025, new laterality options and updates to lung cancer staging have been added.
| Condition | ICD-10-CM Code | Notes |
| Malignant neoplasm of the upper lobe, right lung | C34.11 | The most common code for upper-lobe lung cancer |
| Pleural effusion, malignant | J91.0 | Often used with pleurodesis |
| Benign neoplasm of the trachea | D14.1 | Used when resecting tracheal tumors |
| Post-inflammatory pulmonary fibrosis | J84.10 | Often leads to segmental lung resection |
| Mediastinal mass, unspecified | D38.1 | Valid for mediastinoscopy billing |
Pro Tip: Use additional codes for tobacco use (Z72.0), personal history of smoking (Z87.891), and encounter for surgical aftercare (Z48.81) where applicable.
Real-World Tip for 2025: Bundled Reimbursement Watch
Thoracic surgeries are frequently part of bundled payments, especially for lung cancer resections. Ensure accurate modifier use (e.g., -59, -XS) when billing separately performed procedures during the same session.
Common Error:
Incorrect: Billing CPT 32666 (VATS lobectomy) and 32100 (thoracotomy) separately.
Correct: Bill only the VATS code. Thoracotomy is considered part of the VATS approach.
Modifiers, Mistakes, and Money: How to Bill Thoracic Surgery the Smart Way
Billing thoracic surgery procedures isn’t just about picking the right CPT or ICD-10 code — it’s also about knowing when to add the right modifier, when not to, and how to adapt your claims based on your payer. Even a technically correct claim can get denied without these little billing details.
Modifiers That Matter in Thoracic Surgery Billing
Modifiers help clarify the who, what, when, and where of a procedure. Here are the most essential ones for thoracic procedures in 2025:
| Modifier | Use Case | Example |
| -59 | Distinct procedural service | When a thoracotomy is performed unrelated to the thoracic surgery |
| -XS | Separate structure | When two distinct anatomical areas are involved |
| -22 | Increased procedural services | For exceptionally complex thoracic surgeries requiring extended time |
| -52 | Reduced services | Used if part of the procedure was not performed, e.g., partial lobectomy |
| -24 | Unrelated E/M during postop | Office visit during the global period for an unrelated issue |
| -25 | Significant, separately identifiable E/M on the same day as the procedure | e.g., consultation and pleurodesis on the same day |
Tip: Always provide documentation (such as op notes or surgeon’s explanation) when using modifiers -22 or -59 to avoid denials.
Top 5 Mistakes in Thoracic Surgery Billing (And How to Avoid Them)
| Mistake | Why It Happens | Avoidance Strategy |
| Billing bundled procedures separately | Lack of knowledge about NCCI edits | Use the NCCI edit Checker |
| Incorrect global day calculation | Overlooking 10-day vs 90-day windows | Refer to the CMS global period files |
| Missing laterality in ICD-10 | Not using C34.11 vs C34.12 correctly | Ensure that pathology reports and imaging match documentation |
| Using outdated CPT codes | Code revisions not implemented in the billing system | Update billing software quarterly |
| Modifier misuse | Applying -59 instead of -XS or not at all | Use payer-specific guidance and audit your modifier usage |
Real-World Billing Scenarios for Thoracic Surgery (2025)
Scenario 1: VATS Lobectomy for Lung Cancer
- CPT Code: 32666 (VATS lobectomy)
- ICD-10: C34.11 (Malignant neoplasm of upper lobe, right lung)
- Modifier Needed? No, unless a separate procedure is performed.
Billing Tip: Ensure that pre-op imaging and pathology report support this diagnosis code. Include Z87.891 (history of smoking) if applicable for complete documentation.
Scenario 2: Mediastinoscopy with Biopsy + Thoracotomy
- CPT Codes: 39401 (Mediastinoscopy), 32100 (Thoracotomy)
- Modifiers: Add -59 to 32100 if unrelated or distinct anatomical areas are involved.
- ICD-10: D38.1 (Neoplasm of uncertain behavior of mediastinum)
Billing Tip: Without proper use of modifier -59, one of these procedures may be denied as “included.”
Payer-Specific Tips: What You Need to Know in 2025
Different payers handle thoracic surgery claims differently, especially when it comes to bundling, pre-authorizations, and medical necessity.
| Payer | Requirement | Key Billing Insight |
| Medicare | Pre-auth is not needed for most procedures, strict on documentation | Must follow NCCI edits and global surgery rules to the letter |
| UnitedHealthcare | Prior authorization is mandatory for lobectomies | Attach clinical rationale with imaging reports |
| Blue Cross Blue Shield | Denials are common for lacking laterality | Always include left/right detail in both CPT and ICD codes |
| Aetna | Accepts -XS over -59 for separate anatomical sites | Review modifier guidance in their 2025 policy update |
Pro Tip: Maintain a payer-specific billing policy cheat sheet at your clinic to avoid repetitive denials.
Quick Reference Table: Thoracic Surgery RVU Updates in 2025
CMS has made subtle but meaningful RVU adjustments for several key CPTs used in thoracic surgery.
| CPT Code | 2024 RUV | 2025 RUV | % Change | Note |
| 32666 | 31.25 | 32.35 | +3.5% | Recalibrated for time and complexity |
| 32480 | 34.40 | 34.40 | 0% | No change |
| 39401 | 10.75 | 11.20 | +4.2% | Increase due to recognition of physician effort |
| 32505 | 14.20 | 14.00 | -1.4% | Slight decrease due to bundling of imaging components |
Where You Bill Matters — Thoracic Surgery in Inpatient vs. Outpatient Settings
In thoracic surgery billing, site-of-service significantly influences documentation, billing, and reimbursement. Whether your procedure is done in an inpatient hospital, an outpatient hospital, or an ambulatory surgery center (ASC), the rules shift slightly. In 2025, CMS continues pushing outpatient and ASC settings to reduce inpatient stays and costs, but that comes with tighter scrutiny on coding accuracy.
Inpatient Billing: Precision Is Profit
When to Bill as Inpatient:
- Complex procedures like esophagectomies
- Patients with multiple comorbidities or prolonged post-op monitoring
| Key Features | Inpatient Billing |
| Form Type | UB-04 (CMS-1450) |
| Code Set | MS-DRGs + CPT + ICD-10 |
| Modifiers | Usually not required on a facility claim |
| Global Period | Surgeon still applies a 90-day global period |
| Revenue Codes | Must align with operating room, anesthesia, recovery, etc. |
Documentation Tip: For inpatient claims, coders must ensure complete diagnosis sequencing: principal diagnosis + comorbidities (CC/MCCs).
Outpatient or ASC Billing: High Volume, High Scrutiny
When to Bill as Outpatient or ASC:
- VATS procedures
- Biopsies, pleurodesis, mediastinoscopy
- Day surgeries with low-risk profiles
| Key Features | Outpatient/ ASC Billing |
| Form Type | CMS-1500 + UB-04 |
| Code Set | CPT+ HCPCS+ ICD-10 |
| Modifiers | Crucial – especially -TC, -26, -51, -59 |
| Global Period | Applies to surgeon billing |
| Bundled Services | Common in outpatient settings – verify which services are included |
Pro Tip: Use modifier -SG on ASC claims for Medicare to designate a facility service.
Documentation Tips That Reduce Denials by 35% (According to 2025 CMS Audits)
Even with the correct CPT or ICD codes, poor documentation is one of the top causes of claim rejection or delay in thoracic surgery. Here are proven strategies to strengthen your charting.
| Must-Have Elements in Op Notes | Why It Matters |
| Procedure approach: VATS/open | Determines CPT selection |
| Laterality left/right | Required for ICD-10 accuracy |
| Pre-op diagnosis and final diagnosis | Must align with the billed ICD code |
| Anesthesia type and surgical time | Can justify complexity, e.g., -22 modifier |
| Specimen sent to pathology | May support the use of biopsy codes |
Audit Tip: Use templated op notes with variable fields to capture required documentation without skipping details.
Reimbursement Strategy: Making the Most of Bundled Thoracic Procedures
As CMS and private payers transition more thoracic procedures into bundled payment models, billing departments must learn how to survive and thrive under these rules.
What’s a Bundled Payment?
It’s a fixed payment for an episode of care, often covering surgery, anesthesia, hospitalization, and follow-ups. Thoracic bundles in 2025 may include:
- Lobectomy episode
- VATS wedge resection
- Esophageal tumor resections
Challenge: Unbundled services billed separately during the global period can be denied outright unless clearly unrelated and supported by modifiers.
Strategy to Maximize Revenue Within a Bundle
| Step | Tactic |
| 1 | Accurately document and code all pre- and post-op comorbidities (can influence DRG weight for inpatient reimbursement) |
| 2 | Use modifier -24 for E/M services unrelated to the surgery during the global period |
| 3 | Track your cost-per-case for bundled procedures to avoid under-reimbursement |
| 4 | Collaborate between coder and surgeon before claim submission for complex or lengthy cases (e.g., add modifier -22 if justified |
2025 Insight: CMS is piloting thoracic-specific bundles under its Enhanced Bundled Care Model. Expect mandatory participation for some providers by 2026 — better to start optimizing now.
Quick FAQ: Site-of-Service and Bundling
Q1: Can a VATS procedure billed as an outpatient be denied because of site-of-service?
A: Yes, if documentation doesn’t support the appropriateness of outpatient care (e.g., missing ASA score or comorbidities).
Q2: What if a patient returns for a pleurodesis after a wedge resection? Can I bill both?
A: Yes, but use modifier -79 (unrelated procedure) to separate the new intervention from the previous surgery’s global period.
Q3: Do payers allow separate payment for pathology with thoracic biopsies?
A: Usually, yes — if billed with modifier -26 (professional component) and the facility bills -TC (technical component).
The 2025 Reimbursement Landscape for Thoracic Surgery Billing
As reimbursement models shift and CPT valuations get updated, staying on top of these changes can make or break your thoracic surgery billing success in 2025. CMS and commercial payers have already implemented subtle but important changes that impact how much you get paid for each procedure.
CMS and Private Payer Reimbursement Rates (2025)
Thoracic procedures remain some of the highest RVU-weighted surgeries, especially when they involve complex resections or minimally invasive approaches like VATS. Here’s how 2025 rates look:
| CPT Code | Procedure | 2025 RVUs | Avg Medicare Reimbursement | Commercial Reimbursement Est. |
| 32480 | Pneumonectomy | 34.40 | ~$1,289 | ~$2,575-$3,000 |
| 32666 | VATS lobectomy | 32.35 | ~$1,211 | ~$2,400-$29,00 |
| 32507 | VATS wedge resection | 23.90 | ~$895 | ~$1,850-$2,200 |
| 39401 | Mediastinoscopy | 11.20 | ~$419 | ~$820-$950 |
| 32551 | Chest tube insertion | 6.20 | ~$232 | ~$460-$560 |
Reimbursement is calculated using the CMS conversion factor for 2025 ($37.48).
Commercial rates are generally 2x–2.5x the Medicare rates.
CPT Valuation Insights: What Changed in 2025?
2025 brought RVU recalibrations for several high-volume thoracic CPT codes. These updates were based on revised physician work surveys, OR time audits, and post-op care complexity.
| CPT Code | 2024 RVUs | 2025 RVUs | %Change | Reason |
| 32666 | 31.25 | 32.35 | +3.5% | More intraoperative time + higher post-op risk |
| 39401 | 10.75 | 11.20 | +4.2% | Updated clinical work intensity |
| 32505 | 14.20 | 14.00 | -1.4% | Slight drop due to overlap with imaging services |
| 32557 | 20.60 | 20.60 | No change | Maintained valuation due to stable utilization |
Key takeaway: RVU increases = better Medicare rates, but only if documentation supports the full intensity of the procedure.
Modifier Impact on Reimbursement
Modifiers aren’t just about compliance—they directly affect whether or not you’re fully reimbursed. For example:
| Modifier | Impact |
| -22 (Increased Procedural Services) | Can boost payment by 20-30%, if approved |
| -59/-XS (Distinct Service/ Structure) | Prevents bundling denials, allowing full payment |
| -26 (Professional Component) | Ensures the physician gets paid separately from the facility |
| -80 (Assistant Surgeon) | Up to 16% of the primary procedure’s allowable |
Pro Tip: Always include op notes with -22 claims to justify higher payment and prevent delays.
Compliance and Audit Risks in 2025
Payers are targeting thoracic surgery billing for overpayments and bundling misuse audits, especially when multiple CPTs are used or modifiers are over-applied.
CMS 2025 Audit Priorities (Thoracic-Related)
- Unbundled VATS codes billed with lobectomies
- Inappropriate -59 or -XS modifier usage
- E/M codes during the global period without modifier -24
- Pathology billing without medical necessity for biopsy
How to Protect Yourself:
| Compliance Step | Why It Works |
| Perform quarterly internal audits | Spot trends in denials or overuse of certain codes |
| Keep modifier policy cheat sheets by payer | Prevent accidental misuse that triggers red flags |
| Integrate pre-bill review tools | Catch errors before submission |
| Train physicians on op note expectations | Ensures clinical documentation supports the codes |
FAQs: 2025 Reimbursement Edition
Q1: Is VATS reimbursed better than open surgery?
A: Often yes. Despite slightly lower RVUs, VATS procedures get fewer denials and better acceptance from payers when properly coded, thanks to lower complication risks and quicker recovery times.
Q2: Can assistant surgeons bill for thoracic procedures?
A: Yes, but only with modifier -80 or -82 (if in teaching facilities without residents). Not all payers reimburse this — always check their policy.
Q3: Does Medicare require prior authorization for thoracic surgeries?
A: For most thoracic procedures, no, unless part of a Prior Authorization for Certain Hospital Outpatient Department (OPD) Services list. Commercial payers? Definitely yes.
The Thoracic Billing Success Toolkit (2025 Edition)
The Thoracic Billing Quick-Reference Checklist (2025)
| Step | What to Check | Why It Matters |
| 1 | Correct CPT code (e.g., 32666 vs 32480) | Impacts RVU weight and payment |
| 2 | ICD-10 matches op note and pre-op Dx | Diagnosis-code mismatch = claim rejection |
| 3 | Modifiers applied properly (-22, -59, 24) | Prevent bundling issues and enhance payment |
| 4 | Procedure approach and laterality documented | Required for both ICD-10 and CPT |
| 5 | E/M coded separately if not global | Must use -24 modifier if inside global period |
| 6 | Assistant surgeon/ modifiers validated | Needed for -80/-82, only when allowed |
| 7 | Pathology or imaging linked with modifier -26/-TC | Ensures both the provider and the facility are paid |
| 8 | Authorization requirements checked (if payer needs it) | Avoid full denials on pre-auth-required cases |
Hot Tip for 2025: Pay attention to CMS’s ongoing bundling initiatives. If your procedure is in a bundled payment model, audit your associated services to make sure nothing “extra” was billed outside the bundle.
Documentation Essentials – Never Skip These in 2025
Here’s your must-have documentation bundle that satisfies both CMS and commercial payers during audits:
| Required Section | What It Should Include |
| Operative Note | Procedure, approach (VATS/Open), time, laterality, complications |
| Anesthesia Record | ASA score, duration, and type of anesthesia |
| Pathology Order | What specimen was sent, medical necessity |
| Post-op Care Note | Supports global period follow-up billing |
| E/M Justification | New problem or unrelated complaint = modifier -24 |
Coding Best Practices for Higher Reimbursements
- Pair diagnostic imaging CPTs with thoracic surgical codes wisely — and don’t forget modifier-59 when needed.
- Use Z codes (e.g., Z87.891 – Personal history of tobacco use) as secondary ICD-10 codes to explain thoracic conditions or risk factors.
- Audit high-dollar CPTs quarterly (anything over $1,000 Medicare value) to ensure you’re capturing complexity without overcoding.
- Bundle-aware coding: Know when your procedure is part of an episode, and avoid unbundled charges that will be automatically denied.
Bonus: Quick CPT + ICD Pairing Table
| Procedure | CPT Code | Common ICD-10 Codes (2025) |
| VATS lobectomy | 32666 | C34.11 (Malignant neoplasm of upper lobe, right lung) |
| Chest tube placement | 32551 | J93.83 (Other air leak) |
| Mediastinoscopy | 39401 | C77.1 (Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes) |
| Esophagectomy | 43117 | C15.9 (Malignant neoplasm of esophagus, unspecified) |
| Wedge resection | 32507 | D14.3 (Benign neoplasm of bronchus and lung) |
Tip: Always double-check ICD-10 codes for laterality and specificity. CMS has become stricter with generic or unspecified codes.
Final Words: Winning the Billing Game in 2025
Thoracic surgery billing in 2025 is a balancing act between precision, policy awareness, and proactive coding. With more surgeries shifting to VATS, bundling rules expanding, and compliance scrutiny tightening, staying ahead requires you to:
- Automate and educate: Use billing software with NCCI edits, but never stop training your staff.
- Customize your cheat sheets per payer: Aetna, Cigna, UHC, and Medicare don’t always play by the same rules.
- Get ahead of audits: If you’re getting more than 10% of your claims denied for modifiers, E/M, or diagnosis mismatch, it’s time for a billing audit.
And most importantly, value your coding team. Behind every accurate thoracic claim is a coder who caught that modifier, found the right ICD-10, or noticed that VATS should’ve been billed with 32666 and not 32480.
Billing for thoracic surgery is not just about codes—it’s about strategy, documentation, and foresight. If you master the art of combining CPT logic, ICD precision, and compliance awareness, you don’t just get reimbursed — you get paid right, on time, and fully. In order to get detailed and updated information about medical coding and billing, go through other articles on the website, and don’t forget to call “Medstar Billing Services” to get a hundred percent accurate reimbursement for your services.
