92928: Standard single-lesion coronary stent
Cardiology Billing Specialists
Cardiology Billing Services
Cardiology practices lose millions each year not from a lack of patients, but from billing errors that never should have happened. Modifier mistakes. Missing AUC documentation. Cath-lab charge lag. We fix all of it.
Performance vs. Benchmarks
Cardiology Performance Benchmarks
Key Metrics
Cardiology Practice
Portfolio-Wide Standard
Industry Median (AAHAM)
DSO (Days Sales Outstanding)
↓ 28.5 Days
< 30 Days (Target)
35.2 Days
Clean Claim Acceptance Rate
✓ 97.4% ↑
> 95% (Target)
94.1%
Net Collection Rate (NCR)
✓ 98.2% ↑
> 98% (Target)
96.5%
Aging A/R > 90 Days
↓ 6.1%
< 7% (Target)
10.5%
Overall Recovery Rate
✓ 88.4% ↑
> 85% (Target)
41% AAHAM Median
Core Revenue Fractures
Why Generalist Billing Fails Cardiology
Extensive CPT ranges, multi-vessel modifier rules, and extreme payer scrutiny. Generalist systems treat cardiovascular claims like standard medicine.
Cath Lab Charge-Lag & Bundling
Delayed charge entry postpones reimbursement by weeks. Under 2026 rules, branch vessel interventions are bundled into primary vessel codes. Our real-time capture maps lines within 48 hours of discharge.
EP Global Period Overlaps
Device implantations and EP studies have complex global timelines. Generalist billers mismanage concurrent care tracking, causing duplicate rejections. We monitor overlapping timelines precisely.
Modifier Misuse on Diagnostic Bundles
Incorrect -59 and -XS application on simultaneous echo and stress test combos drives NCCI edit denials. Our automated scrubbing validates modifier-to-code pairings against real-time carrier rules.
Prior Auth & Commercial AUC Blocks
While CMS paused federal AUC penalties, commercial insurers enforce hidden criteria — PA blocks and retrospective audits on cardiac CT, MR, MPI, and stents. We route through qualified qCDSM to secure clean authorizations.
Procedure-Specific Coding
Cardiology Coding Expertise
Updated with active AMA and CMS guidelines, replacing outdated code sets with precise documentation filters.
Interventional
Complex PCI & 2026 Revisions
Natively implementing the major CPT updates for Percutaneous Coronary Interventions.
Peripheral Vascular
LER Overhaul: 46 Territory-Specific Codes
Legacy 37220–37235 deleted. Replaced by 37254–37299 categorized by anatomical zone.
Diagnostics
Echo, Nuclear & Stress Imaging
Absolute documentation verification for high-volume diagnostic streams.
Remote Monitoring
Tele-Cardiology & Short-Period RPM
Updated 2026 guidelines for virtual care and device telemetry.
Care Management
Chronic Care (CCM) & Transitional Care (TCM)
High-risk heart failure and post-discharge coronary populations. We accurately report CCM (99490, 99491), Principal Care Management (99439), and TCM (99495, 99496) to convert routine clinical coordination into a compliant, steady revenue stream.
Complete RCM Pipeline
4-Phase Cardiology Financial Engine
Compressed pipelines eliminating leakage across interventional, EP, heart failure, and structural heart care.
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Front-End Access & CMS-0057-F
Eligibility verification and complete PA lifecycle for TAVR, defibrillator implants, and angioplasties. 7-day standard and 72-hour expedited windows.
Mid-Cycle Precision
Certified coders translate complex operative notes. Split/shared billing rules determine attending vs. NP/PA billing based on substantive medical decision-making.
Scrubbing & Submission
Real-time NCCI edits, MUE tables, carrier- specific rules. ANSI X12 837 streams to Availity and Change Healthcare clearinghouses.
Appeals & Reconciliation
Immediate root-cause reviews on rejections. Contract compliance analytics flag underpayments below negotiated fee schedules.
2026 Compliance
Interoperability, MIPS & Enterprise Security
Protect your margins against shifting payer policies and the expansion of bundled payment models.
MIPS MVP Tracking
Real-time performance monitoring for cardiology-specific MIPS measures and Value Pathways. Insulates your group from negative 9% Medicare payment penalties.
Advanced Device Interoperability
Automated bots interface with cardiovascular PACS, digital echo labs, and LIS tracking cardiac troponin/BNP. HL7 ORU-R01 and FHIR data standards eliminate manual double-entry.
Balance-Billing & NCD Compliance
Automated GFEs for elective cath lab procedures. Compliant billing workflows for cardiac rehab NCD 20.10.1 and intensive cardiac rehab NCD 20.31.
Enterprise-Grade Security
SOC 2 Type II certified across five trust criteria. Full HIPAA BAAs and bank-grade TLS 1.3 encryption on all transmission pipelines.
Proven Results
Cardiovascular Success Stories
Modifier Recovery
Resolving Cath Lab Modifier Errors
A multi-physician interventional practice had an 18% denial rate on diagnostic catheterizations from incorrect -59 vs. -XS modifier usage. We reconfigured charge capture and deployed automated NCCI editing.
97.4%
Clean Claim Rate
-12
Days A/R Reduced
$64K
Cash Recovered
RPM Revenue
Scaling Revenue via RPM Integration
A regional cardiovascular group wanted to deploy remote cardiac monitoring but was overwhelmed by data tracking requirements. We integrated device telemetry into automated billing.
$142K
Annual RPM Revenue
Zero
Added Admin Tasks
100%
CMS Compliant
Take the Headache Out of Cardiovascular Billing
Request a free cardiology billing assessment. Our specialists will identify exactly where your practice is losing revenue and show you the path to 97.4%+ clean claim performance.
FAQs
How do you handle the 2026 CMS split conversion factor?
We counter the split conversion factor ($33.57 APM / $33.40 traditional) and the 2.5% efficiency cuts by automating front-end verification. Our platform eliminates simple administrative rejections, ensures exact modifier use, and reduces manual labor, which directly protects your practice profits.
How do you bill multi-lesion stenting under 2026 complex PCI guidelines?
Legacy branch add-on codes are gone. If your interventionalist treats multiple separate segments or handles complex bifurcations, our engine automatically applies the primary code CPT 92930 to secure your full reimbursement.
What are the 2026 peripheral vascular LER billing rules?
The old 37220–37235 series has been completely deleted. It is replaced by 46 territory-specific codes spanning 37254–37299. Providers must select codes based on the specific arterial territory (Iliac, Fem-Pop, Tibial, Inframalleolar) and document whether the lesion was a basic stenosis or a complex total occlusion.
Are the short-period RPM codes (99445, 99470) active and billable?
Yes. Finalized under current CMS guidelines, CPT 99445 allows you to bill for device data transmission with as few as 2 to 15 days of monthly readings, while CPT 99470 triggers reimbursement at a lower 10-minute clinical staff threshold per month.
How do you handle CMS-0057-F prior authorizations?
Our automated system tracks payer-specific rules for interventional devices and advanced diagnostic studies. We secure required authorizations before patients enter the cath lab, enforcing the 7-day standard and 72-hour expedited decision windows to prevent care delays.