Cardiology Medical Billing Services
Cardiology billing lives on the boundary between diagnostic and interventional work, and payers police that boundary hard. A single cath lab visit can generate a professional component, a technical component and a facility charge, and getting the split wrong is not a coding error the scrubber will catch.
Codes this specialty bills most
| Code | Description | Watch for |
|---|---|---|
| 93000 | Electrocardiogram, routine ECG with at least 12 leads, with interpretation and report | Billing 93000 alongside a same-day E/M draws scrutiny when the ECG was the reason for the visit rather than a separate service. |
| 93010 | Electrocardiogram, interpretation and report only | The professional component. Billing 93000 when the practice did not own the tracing is a common overbill. |
| 93306 | Transthoracic echocardiography, complete, with spectral and color flow Doppler | Denies when the documentation does not establish why a complete study was needed rather than a limited one. |
| 93458 | Catheter placement in coronary arteries with imaging supervision and interpretation | Same-day diagnostic imaging is frequently bundled into this. Check the payer policy before appealing. |
The denials this specialty sees
Bundling is the recurring theme. When a diagnostic study and an intervention happen in the same session, payers will usually treat the diagnostic work as included, and they are often right. The appealable cases are the ones where the diagnostic study genuinely drove the decision to intervene, and that argument only works if the note says so explicitly. See CO-97 for how these are worked.
The second pattern is component splitting. Echo and stress testing carry a professional and a technical component, and practices routinely bill the global code when they only performed one half. This does not always deny. Sometimes it pays at the wrong rate, which is worse, because nothing flags it.
The third is medical necessity on advanced imaging. Payers apply tight coverage criteria to cardiac CT and MRI, and a referral that just says "chest pain" will not survive review. See CO-50.
Our billing and RCM service puts an MD on these before submission, which is the point at which a bundling problem is still cheap to fix.
Payer notes
Medicare's National Coverage Determinations govern most advanced cardiac imaging, and commercial payers generally follow them with their own additions. Check the current NCD rather than working from a summary; these get revised.
Several large commercial payers require prior authorization for cardiac CT and nuclear stress testing. The authorization has to be on file before the study, not before the claim.
Common questions
Why does our ECG keep getting bundled into the office visit?
Usually because the documentation reads as though the ECG was the reason for the encounter rather than a separate service performed during it. If the visit addressed something else and the ECG was ordered on top of that, the note has to show both. If it did not, the bundle is correct.
Should we bill 93000 or 93010?
It depends on whether your practice owns the equipment and the tracing. 93000 is the global service. 93010 is the interpretation alone, which is what you bill when someone else performed the tracing. Billing global when you only interpreted is a repayment risk.
Can we appeal a denied cardiac CT?
Often, if the referral documented specific clinical findings that meet the payer's coverage criteria. If the referral said "chest pain" and nothing else, the appeal will not succeed and the time is better spent fixing the referral template.
See what your claims are leaving behind
Send us a month of remittance data and we will tell you what it says: which codes are being denied, how much of it is recoverable, and how long your money is sitting in A/R. It takes about a week and there is nothing to sign.