Cardiology billing and coding
Cardiology billing that gets testing, interpretation and prior auth right
Cardiology revenue depends on diagnostic testing. Split billing, prior authorizations and frequent payer edits make it one of the easiest specialties to under-collect.
What makes cardiology billing hard
Professional and technical splits
Echo, stress and nuclear studies must be billed globally or split with modifiers 26 and TC depending on who owns the equipment.
Prior authorization
Advanced imaging often needs authorization in advance. A missing number turns into a denial weeks later.
Medical necessity
Diagnosis codes must support the test under each payer's coverage policy, or the claim is denied.
Codes we see every day
Examples of the codes and modifiers our coders handle for this specialty.
| Code | What it describes |
|---|---|
| 93000 | Routine ECG with at least 12 leads, with interpretation and report |
| 93306 | Complete transthoracic echocardiogram with Doppler |
| 78452 | Myocardial perfusion imaging (SPECT), multiple studies |
| Modifier 26 / TC | Professional component / technical component of a diagnostic service |
CPT codes and descriptions are summarised for readability. Always code from the current code set and payer policy.
How we help
- Check authorization status before imaging is performed
- Apply 26/TC correctly for hospital-based and in-office testing
- Match diagnoses to each payer's coverage policy before submission
- Track underpaid testing claims against your contracted rates
Related services: Medical billing, Medical coding, Medical transcription, Revenue cycle management, Denial management