Maximizing Revenue: Top 5 Cardiology Billing Mistakes to Avoid

Top 5 Costly Billing Mistakes

1. Incorrect Bundling of Procedures

One of the most common errors is failing to understand which procedures can be billed separately and which are bundled.

• Diagnostic cath with PCI - proper code selection
• Multiple vessel interventions - modifier usage
• Imaging guidance - when to bill separately

2. Missing or Incorrect Modifiers

Modifiers are critical for accurate cardiology billing:

• Modifier 59 - Distinct procedural service
• Modifier 26/TC - Professional vs. technical components
• Modifier 76/77 - Repeat procedures
• Modifier LT/RT - Left/right side designation

3. Inadequate Documentation

Poor documentation is a leading cause of denials:

• Missing procedural details
• Incomplete vessel identification
• Lack of medical necessity justification
• Insufficient complication documentation

4. Incorrect E/M Coding with Procedures

Evaluation and Management services require careful coding:

• When E/M is separately billable
• Modifier 25 requirements
• Documentation standards for same-day E/M

5. Failure to Verify Coverage

Not all procedures are covered by all payers:

• Pre-authorization requirements
• LCD/NCD compliance
• Experimental procedure exclusions
• Frequency limitations

Best Practices for Error Prevention

1. Regular staff training on coding updates
2. Implement pre-billing audits
3. Use coding software with built-in edits
4. Maintain current coding resources
5. Conduct quarterly compliance reviews