Specialty billing / Cardiology
Cardiology bills three different businesses at once. There is office evaluation and management, a diagnostic arm with global, professional and technical splits, and an interventional arm where a single cath lab session can generate a dozen codes governed by bundling edits. Each moves under different rules, and revenue leaks where they meet.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
Where it breaks
Echocardiograms and stress tests read in the office bill globally, but the same study read at a hospital bills professional only. Practices that use one charge template for both settings either lose the technical fee or bill for equipment they do not own.
Diagnostic catheterization performed during the same session as an intervention is often included in the intervention. Reporting both without documentation that the diagnostic study prompted an unplanned decision to treat draws automatic edits.
Pacemaker and defibrillator monitoring codes carry fixed reporting periods of 30 or 90 days. Billing a cycle early, or billing twice inside one window because a patient transmitted extra data, produces frequency denials that are tedious to unwind.
Peripheral interventions have distinct code families by vessel territory, and several include the catheterization and imaging in the base code. Selecting from the wrong family under-reports work or triggers a component billing denial.
Frequently billed
Representative codes only. Actual coding follows current CPT/HCPCS guidance and payer policy.
Denials we prevent
FAQ
Use modifier 26 when your physician interprets a study performed on equipment your practice does not own or staff, typically a hospital echo or nuclear scan. If the study is performed and read entirely in your office with your equipment and technician, bill the code globally with no component modifier.
Sometimes. If the diagnostic study was already planned and the anatomy was known, it is bundled into the intervention. If the diagnostic catheterization was performed to evaluate the patient and led directly to an unplanned decision to intervene, it can be reported separately with appropriate documentation and modifier support in the procedure note.
Pacemaker and implantable defibrillator remote monitoring codes carry defined reporting periods, commonly 90 days for implanted devices and 30 days for certain monitors. One unit per completed period is payable regardless of how many transmissions the patient sends. Tracking the cycle start date per patient prevents frequency denials.
Most denials trace to coverage policy rather than coding. Payers publish specific indications, and documentation of chest pain alone frequently falls short. Recording risk factors, prior test results, symptom characteristics and the clinical question the study will answer aligns the note with the policy language reviewers check.
We compare paid amounts against your contracted fee schedule line by line, not just against billed charges. Interventional and imaging codes are where silent underpayment concentrates, because a single misapplied multiple procedure reduction can look like a normal adjustment. Variances are appealed with contract language attached.
Other specialties
Next step
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.
