Vascular surgery billing is extraordinarily complex and is probably the most complex of all the medical coding specialties.  We have experience with many surgical specialties, including many of the most complex including spine (neurosurgery billing and orthopedic billing for spine) and the consensus among coders is that vascular is the most difficult.


Vascular billing (and more specifically coding) requires an extremely strong understanding of anatomy.  Endovascular is very challenging.  Coders must be able to read the operative report and know exactly where the vascular surgeon went without having to ask questions that waste the surgeon’s time.  The number and complexity of all of the branches in the trees can be daunting.  Our vascular surgery coders must know all the branches including second and third order vessels sufficiently well to be able to pick the appropriate codes.  Small changes in sister or cousin vessels result in completely different CPT codes.


And don’t forget the much feared bypasses configurations, which also make coding these vascular procedures incredibly difficult.  Did you detour, in other words bypass some anatomy?  Where did you come from and where did you end up? How many bifurcations did you pass?


This poses challenges in terms of documentation.  A top vascular billing company will work with its surgeons in order to make sure they are documenting not only everything required for compliance, but everything to ensure that the coding allows the maximum reimbursement for the work that was done.  As a vascular billing service, we will often see cases where it is likely that a particular approach or procedure was performed since we had seen other cases like that, but it simply wasn’t documented.  This is a great example where asking the surgeon for clarification on what was actually performed can result in greater reimbursement and better compliance.


Then there are the constantly changing rules around vascular coding bundling, annual changes from Medicare and the AMA, as well as all of the different payer rules.  Some payers adopted the bundling of 2012 while others still have not for example.  Knowing all of these rules is critical for a vascular surgery billing company in order to maximize the revenue cycle management for our clients.


The rules have undergone a great deal of changes recently and will continue to do so in the coming years.  Many procedures that were billed individually in past are now bundled into one CPT.  Staying on top of these changes is a great deal of work and there are huge economies of scale.  When we track and monitor the coding changes for all our vascular surgery billing clients, we do this for dozens of physicians, which is far more cost effective than each practice doing it themselves.  Staying on top of changes in general and vascular surgery billing is important not only for compliance, but to maximize the compliant reimbursement in an increasingly difficult reimbursement landscape.  This is why choosing the right vascular billing service is so critical.


About Apache Health

Apache Health is a revenue cycle management (RCM) analytics, benchmarking, and auditing company. The founders of Apache formerly ran a large RCM company that was acquired by a private equity group in a rollup. Apache’s predictive analytics will benchmark billing performance and project exactly how much more revenue you should earn from your existing volume of patients.  Using many factors and a blend of artificial intelligence and specialty specific benchmarks, the model projects whether changing the billing process would improve collections for your particular mix of procedures and payers. Apache Health can help you evaluate whether to outsource the billing, determine which billing company to select to maximize performance, or track in-house billing performance improvement over time. For more information contact:


Sean McSweeney

Apache Health