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Experienced with cardiac diagnostic and procedural billing
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Cardiology billing combines E/M visit coding with diagnostic testing and procedural coding, often within the same visit. Getting the bundling rules right between these code types is where most cardiology denials happen.
A cardiology visit often includes a test, a procedure, and an evaluation in one encounter. Billing all three correctly, without triggering an improper bundling edit, requires coders who understand cardiac-specific NCCI rules, not general coding knowledge applied from a different specialty.
Anthem and Aetna in Connecticut require prior authorization for many advanced cardiac imaging and procedural services, and the criteria differ by plan and by specific test order.
| What You Get | In-House Billing | Connecticut MedBill |
|---|---|---|
| Diagnostic and procedure billing | Reviewed separately | Coordinated within the same claim |
| NCCI edit review | May rely on payer rejections | Checked before claim submission |
| Imaging authorization | Often tracked manually | Monitored throughout scheduling |
| Technical and professional billing | Modifier errors can occur | Components reviewed before billing |
| High-value claim follow-up | Competes with routine billing work | Prioritized until payment is resolved |
Cardiology claims often involve procedures, imaging, and multiple services performed during the same episode of care. Strong revenue cycle management helps those higher-value claims move through payer review with fewer delays.
Authorization management, documentation review, procedural coding, and consistent follow-up all contribute to a healthier accounts receivable process.
We code both separately when documentation supports a significant, separately identifiable service, applying the correct modifier so the claim is not denied as duplicate billing.
Many commercial plans require prior authorization for echocardiograms and other advanced cardiac imaging. We verify authorization requirements before the test is scheduled.
Our coders review each procedure combination against current NCCI edits before submission, applying modifiers only where the edit rules allow it.
Yes. We code diagnostic and interventional cardiac catheterization procedures, including associated stent placement when performed in the same session.
We verify HUSKY-specific authorization and documentation requirements for cardiac procedures before submission, since HUSKY’s review process does not always match commercial payer rules.
A complete echocardiogram, 93306, covers a full standard study, while a limited or follow-up study uses a different code and reimburses differently. Billing every study as complete regardless of scope is a common overcoding risk.
Yes, when the equipment and interpretation are performed by different parties, we apply the correct modifier to bill each component appropriately.
Device monitoring services follow their own set of monthly or periodic billing codes, distinct from in-office visit codes, and we track monitoring periods separately from office encounters.
Filing limits vary by payer, typically 90 days to one year. We track each payer’s specific deadline so appeals are never missed.
Yes. Stress testing uses its own code set distinct from a resting EKG, and the specific code depends on whether tracing, interpretation, or both are being billed.
