Cardiology revenue lives in the diagnostic stack. Every study needs the right technical and professional split, the right modifiers, and the right medical necessity. Miss one and the claim denies. We do not miss them.
We see the same patterns across cardiology groups. The leaks are specific, recurring, and fixable with coding discipline and payer-aware claim construction.
Not a complete list. A representative slice of the codes that drive revenue and denials for cardiology practices.
| Code | Description | Profile |
|---|---|---|
| 93000 | EKG with interpretation and report | High volume |
| 93306 | Transthoracic echocardiogram, complete with Doppler | Modifier-sensitive |
| 93015 | Cardiovascular stress test, complete | Denial-prone |
| 93458 | Coronary angiography with left heart cath | High volume |
| 93656 | Atrial fib ablation | Modifier-sensitive |
| 93228 | Mobile cardiac telemetry | Denial-prone |
| 93294 | Pacemaker remote interrogation | High volume |
TC and 26 splits billed correctly based on site of service. NCCI edits screened before submission. Prior auth tracked for every study that requires it. High-value interventional coding reviewed by a specialty-certified coder before submission.
Pattern we see. Medical necessity on repeat echos, stress test plus EKG bundling, and prior auth not on file for advanced imaging. We fix the pattern upstream so they stop recurring.
How we fix it. Every denial is logged against its CARC/RARC code and routed to a coder who owns the appeal. We rebuild the claim with the documentation the payer is actually asking for, not a generic reconsideration letter. Recovery rate on appealable cardiology denials averages above 60 percent.
A written 30-day diagnostic. Dollar figures against every finding. No obligation.