Cardiology billing turns on a distinction most specialties never touch: whether you performed the study, interpreted it, or both. Get the professional and technical split wrong and the claim either underpays or denies outright, and the correct answer changes depending on whether the study happened in your office or at a hospital.
Layered on top is bundling. Echocardiography, stress testing and nuclear studies each carry component codes that payers expect to see combined in specific ways, and those expectations are not uniform across carriers.
What trips cardiology claims up
- Professional and technical components billed to match where the study was performed
- Echo, stress and nuclear studies checked against bundling edits before submission
- Device and monitoring codes matched to the documented interpretation
- Diagnostic versus interventional catheterisation coded from the operative report
What we check before a claim goes out
- Modifier 26 for the professional component, TC for the technical
- Echo, stress and nuclear study bundling checked per payer
- Device interrogation and monitoring codes matched to the interpretation on file