Registration & eligibility
Confirm demographics, coverage, network status, and referral requirements before a claim is created.
Electrophysiology Revenue Support
Electrophysiology Billing Services for Michigan Cardiology Practices
Electrophysiology carries some of the most detailed coding and documentation requirements in cardiology. Ablation, device implantation, interrogation, and mapping can all appear in the same encounter, and each one carries its own rules for medical necessity, bundling, and payer authorization. We manage that workflow for Michigan practices, from the first eligibility check through the last unpaid claim on the aging report.
Built around CPT and HCPCS reporting rules for EP studies, ablation, and cardiac device services, along with the professional and facility billing distinctions that apply to each.
What We Handle
Billing support built around electrophysiology
Electrophysiology claims move through several stages before a payment posts. We work each stage directly, so a documentation gap or a coding question gets caught before it turns into a denial.
Prior authorization tracking
Monitor payer authorization requirements for ablation, device implantation, and other EP procedures that require approval in advance.
Charge capture & coding
Translate the procedure note into CPT, HCPCS, and ICD-10-CM codes, with modifiers applied only when documentation supports them.
Claim submission & tracking
Scrub claims for common rejection triggers, transmit through the clearinghouse, and track status until the payer responds.
Denial management
Research the payer's reason code against claim history, then correct, resubmit, or appeal based on what the payer requires.
Payment posting & A/R
Post ERA and EOB activity, apply contractual adjustments, and follow up on aging balances and underpayments.
Procedure Coding
Coding that matches what EP actually involves
An EP encounter can include a diagnostic study, an ablation, device work, and imaging in the same visit. Each component has its own code, and not every combination is billable together.
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Electrophysiology studies
Diagnostic evaluation of the heart's conduction system, generally reported using codes from the 93600 series depending on what was measured.
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Catheter ablation
Arrhythmia-focused procedures for atrial fibrillation, atrial flutter, SVT, and ventricular tachycardia, each with distinct CPT codes and bundling rules.
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Mapping & imaging
Three-dimensional electroanatomic mapping and intracardiac echocardiography, billed separately from the ablation when documentation supports it.
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Device implantation & management
Pacemaker and ICD implantation, generator changes, lead extraction, interrogation, and remote monitoring, each with its own code set and global period rules.
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Loop recorders & cardioversion
Insertable cardiac monitors and electrical cardioversion, coded according to the service actually documented rather than a default assumption.
Documentation Review
Turning the procedure note into a clean claim
Coding accuracy depends on what the physician wrote down. We flag documentation gaps early so the claim goes out complete the first time.
Coding review
We check that the diagnosis code supports the procedure billed and that the CPT and HCPCS codes reflect the technique the physician actually used, not a generic template.
Bundling edits, mutually exclusive procedure combinations, and modifier requirements are reviewed against current payer policy before the claim leaves our queue.
Documentation checks
A complete EP note names the arrhythmia confirmed, the vessels or chambers accessed, any devices implanted or interrogated, and the physician's direct involvement in the procedure.
When a note is missing one of those details, we send it back for clarification before coding, rather than guessing at what was likely done.
How a Claim Moves
From the first visit to the final payment
Each claim passes through the same sequence, whether it is a routine device check or a same-day ablation with mapping.
1
Verify & authorize
Confirm coverage, benefits, and any prior authorization the payer requires before the procedure is scheduled.
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Document & code
Review the procedure note, assign CPT, HCPCS, and ICD-10-CM codes, and apply modifiers where the documentation supports them.
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Submit & track
Scrub the claim, submit electronically, and monitor for rejections or status changes.
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Resolve & report
Post payments, follow up on denials and aging balances, and report the outcome back to the practice.
Denials & Follow-Up
Keeping unpaid claims from going quiet
A denied EP claim is rarely a simple fix. We trace it back to the reason code, the documentation, and the payer's specific requirement before deciding how to respond.
Denial management
We read the payer's stated reason, compare it against the original documentation and claim history, and decide whether the claim needs correction, resubmission, reconsideration, or a formal appeal.
A/R follow-up
Aging claims are tracked by payer and balance, underpayments are compared against the contracted rate, and unresolved accounts are escalated before they age out of a payer's filing window.
Who We Work With
EP billing for different practice structures
Electrophysiology billing looks different depending on how a practice is organized. We adjust the workflow to match.
Independent EP practices
Practices managing their own professional billing for diagnostic studies, ablations, and device services.
Cardiology groups
Groups where EP sits alongside general cardiology, interventional, and imaging services.
Multispecialty groups
Organizations where EP billing has to work alongside several other specialties' coding rules.
Hospital-affiliated physician groups
Groups navigating the line between professional billing and the hospital's facility billing.
Cardiovascular centers
Centers handling diagnostic, interventional, and device-related EP services under one roof.
Physician organizations
Organizations providing EP procedures with ongoing payer credentialing and A/R requirements.
Michigan Focus
Built around Michigan's payer mix
Michigan cardiology practices bill against a mix of commercial insurers, Medicare, and Medicaid managed care plans, and each one can set its own authorization and documentation requirements for EP procedures. We track those differences by payer rather than applying one set of rules to every claim.
Commercial payer authorization rules
Medicare coverage and documentation requirements
Medicaid managed care plan variations
Payer-specific claim follow-up
Questions We Hear Often
Electrophysiology billing questions
What does electrophysiology billing actually cover?
It covers the coding, claim submission, payment posting, denial handling, and A/R follow-up for EP-specific services, including diagnostic studies, ablation, device implantation, and remote monitoring.
How is EP billing different from general cardiology billing?
EP procedures often involve more billable components in a single encounter, such as mapping, imaging, and device work alongside the primary procedure, each with its own bundling and modifier rules.
Which EP procedures need the most coding attention?
Catheter ablation, three-dimensional mapping, device implantation, lead extraction, and remote monitoring tend to carry the most documentation and bundling requirements.
How does incomplete documentation affect a claim?
If the note does not clearly identify the technique, the arrhythmia, or the devices used, the coder cannot support the code billed, which raises the risk of a denial or a medical necessity review.
How do you handle a denied EP claim?
We review the payer's reason code against the original claim and documentation, correct anything that needs correcting, and resubmit or appeal depending on what the payer requires.
What's the difference between professional and facility billing for EP?
Professional billing covers the physician's work. Facility billing covers the hospital or surgery center's equipment, staff, and resources. Each uses a separate billing structure and its own set of codes.
Does prior authorization affect how a claim is submitted?
When a payer requires authorization and it was not obtained, the claim is likely to be denied. Some payers also require the authorization reference number to appear on the claim itself.
Do you handle A/R follow-up as part of EP billing?
Yes. That includes tracking unpaid claims by age and payer, contacting payers directly, and working underpayments and denials until the balance is resolved.
Get in Touch
Talk to Our Billing Team →
Talk through your EP billing workload
If ablation, device, or mapping claims are piling up in your denial queue, we can walk through where the workflow is breaking down and how we would handle it going forward.