Cardiology billing
High-dollar procedures, complex modifier rules, and aggressive payer scrutiny — one missed prior auth on a stress test can cost $1,000+ per case.
Cardiology billing is unforgiving — high reimbursement means high audit scrutiny. Practices that get sloppy on documentation pay it back in clawbacks two years later.
Where revenue leaks
The cardiology traps we see most
Patterns we run into across Cards practices in Texas. None are obvious from a 30,000-foot view of the practice — they show up only when someone's actually looking at every claim.
Prior auth gaps on advanced imaging
Stress echo, nuclear stress, cardiac CT, and cardiac MRI all require prior auth from most commercial payers. A missed auth turns a $1,500 procedure into a $0 write-off. Tracking auths is non-negotiable for cardiology.
Professional vs. technical component (modifier 26 / TC)
Studies done in-office often need split billing. Wrong modifier means you bill for the wrong component, get partially paid, and lose the difference. Common on echo (93306), holter (93225), stress test (93015–93018).
Bundling errors on cath procedures
Diagnostic cath + intervention same day has CCI bundling rules. Billing both without modifier 59 (or X{ESPU}) gets the diagnostic portion denied. Conversely, unbundling when bundling is required triggers audits.
Device monitoring under-billed
Pacemaker/ICD remote monitoring (93294, 93295, 93296, 93297) pays per-90-day cycle. Many practices monitor patients without billing the surveillance codes consistently.
Coding focus
Where our coders specialize
- Echo (93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317)
- Stress test (93015 global, 93016 supervision only, 93017 tracing only, 93018 interpretation only)
- Cardiac catheterization (93452–93462, 93571, 93572)
- EP studies (93619–93624, 93653–93657)
- Device monitoring (93279–93298)
- Modifier 26, TC, 59, 25 — used heavily and audited closely
Texas payer notes
Local rules we navigate every day
- BCBS TX, UHC, and Aetna all require prior auth for advanced cardiac imaging — track via specific portal per payer
- Medicare LCDs in Texas (Novitas) have specific documentation requirements for stress testing medical necessity
- Hospital-based vs. office-based service distinction matters for cath lab billing
- Cardiology-specific bundling rules (NCCI edits) update quarterly — coders must stay current
Cards KPIs we track
Specialty-specific benchmarks
We tailor reporting per specialty — these are the metrics that matter most for cardiology.
99%+
Prior auth on-time rate
98%+
Modifier accuracy (audited)
<35
Days in AR for high-dollar procedures
What's your cardiology practice leaking?
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Other specialties we serve