Invasive cardiology billing services
One cath lab visit can produce a diagnostic study, a stent, and a pressure-wire reading, each with its own coding rules. We bill those cases for Invasive cardiology groups.
Medical billing and RCM support for invasive cardiology groups across the States
Coverage and authorization
Note review, charge entry
Filing, rejections and appeals
Posting, follow-up and reporting
Billing built around the way cath labs run
Invasive cardiology billing covers work done through a catheter: heart caths, angiograms, stents, and vessel imaging. The codes, payer edits, and claim change once a diagnostic study turns into treatment.
That means working with Medicare (administered by Novitas Solutions), Texas Medicaid through STAR and STAR+PLUS health plans, Blue Cross and Blue Shield of Texas, and commercial carriers. Each has its own authorization rules and claim edits, so no single workflow fits all.
A diagnostic cath that leads into PCI is reported differently from a stand-alone study. Our coders check the note for when the decision to treat was made.
A hospital or surgery center bills its own facility claim beside the physician's professional one. An office-based lab practice can bill both.
What our invasive cardiology billing covers
Nine stages, from registration through the last reconciliation report, each shaped by cath lab documentation and payer rules.
Patient intake checks
We confirm demographics, active coverage, and network status for both physician and facility.
Prior authorization and referrals
We send clinical records, follow each request to a decision, and log the reference number.
Note review, charge entry
Coders match the procedure note to the charge sheet: vessels treated, devices used, and imaging done.
Code assignment
ICD-10-CM, CPT, and HCPCS codes are assigned, then checked for modifiers and NCCI edit conflicts.
Claim filing and tracking
Claims go out through a clearinghouse. Rejections are worked promptly and status checked until payment posts.
Denial and appeal work
Each denial is traced to its cause, then corrected, resubmitted, or appealed with supporting records.
Remittance posting
ERA and EOB data is posted line by line, with adjustments, patient balances, and recoupments kept separate.
Aging accounts
Balances are worked by payer and age, and underpaid claims are checked against contracted rates.
Reports and reconciliation
Reports show claims filed, denial rates, A/R aging, payments, and underpayments by payer, matched to bank deposits.
Procedures we bill and their rules
Cath, PCI, imaging, and peripheral work each trigger different payer edits and note requirements.
Diagnostic heart caths
Codes depend on what was imaged: coronary arteries, bypass grafts, or the left ventricle.
Right, left, and combined heart caths
Combined studies have their own codes; the note must name each chamber and vessel studied.
PCI, stents, and atherectomy
PCI codes follow the vessel treated, and each extra branch can mean another line.
IVUS and FFR add-on studies
These add-on codes are tied to the vessel studied, so the note must say which vessel and why.
Peripheral artery interventions
Peripheral codes split by territory (iliac, femoral-popliteal, or tibial) and by technique.
Devices and implant records
Stents and other implants appear on the facility claim with device codes, so the implant log and physician note must agree.
Clean claims begin with a complete note
Our coders translate what the physician documented into standard codes, then test the result against payer edits.
- ICD-10-CM: diagnosis codes that support medical necessity.
- CPT: codes for each procedure performed.
- HCPCS: device and supply codes.
- Modifiers: vessel modifiers (LD, LC, RC), -26, and -TC.
- NCCI pairs: bundled code pairs checked before submission.
A usable procedure note names the indication, the vessels or chambers studied, findings, any treatment delivered, devices placed, imaging and pressure measurements, sedation time, the physicians involved, and any complications.
Missing detail leads to physician queries, corrected claims, delayed payment, or a denial.
Confirming coverage and authorization before the cath
Checks made before the procedure date cut rework. We confirm coverage and authorization rules once a case is scheduled.
Deductible, copay, and coinsurance details are pulled before service so patient estimates are accurate.
Plans that require a referral get one confirmed on file before the cath date.
We check whether the planned procedure needs approval and send the records that support medical necessity.
Approved authorization numbers go on the claim, and open requests are tracked to a decision.
Footnote: Requirements differ across Medicare Advantage, Texas Medicaid plans, and commercial carriers, so each case is checked.
Physician and facility claims
One cath can generate a professional claim, a facility claim, or both, depending on the site of service.
Physician claim
Covers the physician's own work, meaning the procedure itself and the interpretation of results.
- Operator services
- Codes, modifiers, and notes
- CMS-1500 claim form
Facility claim
Covers the hospital or center's lab room, staff, supplies, and implanted devices.
- Charges, revenue codes, devices
- Place-of-service codes
- UB-04 claim form
Footnote: Lab ownership and physician employment decide which claims go out, so we map that setup first.
From intake to payment
Every case moves through the same eight steps, from patient registration to the final report.
Intake
Demographics and insurance details are entered and verified up front.
Coverage
Benefits, network status, referrals, and authorizations are confirmed ahead of time.
Notes
The procedure note is reviewed and charges are entered.
Codes
Diagnosis, procedure, modifier, and device codes are assigned and checked.
Claim filing
Claims are formatted per payer and sent through a clearinghouse.
Rejection and denial work
Rejected and denied claims are traced to a cause and corrected.
Payment entry
ERA payments, adjustments, and patient balances are posted to each account.
Follow-up and reports
Open balances are worked, then results go into the reports.
Why cath lab claims need extra care
Stacked codes, detailed notes, differing payer edits, and two-claim setups all raise the odds of a rejected claim.
Early gaps become late problems.
A missing referral or a vague note is easy to fix beforehand. Afterward, it becomes a denial, an appeal, and A/R follow-up.
Contact our cardiology billing teamInvasive cardiology billing services in Texas
We support cardiology groups and hospital cath labs across Texas. For state-regulated commercial plans, Texas prompt-pay rules set a 95-day filing limit and a 30-day payment window for clean electronic claims.
What the reports show
Payer-level reports separate Medicare, Texas Medicaid plans, and Blue Cross and Blue Shield of Texas, so slow payers and underpayments stand out.
Groups that use this service
The service fits independent cardiology practices, interventional groups, physician-owned cath labs, hospital-affiliated cardiologists, and multispecialty groups that have added cath work in Texas.
Cath billing questions, answered
Short answers on procedure coding, prior authorization, denials, and the Texas rules that affect payment timing.
What does invasive cardiology billing involve?
It covers coding, claims, payment posting, and follow-up for catheter-based heart and vessel procedures, starting with the coverage check.
Which procedures does invasive cardiology billing usually cover?
Right and left heart caths, coronary angiography, PCI with stents or atherectomy, IVUS, FFR, and peripheral artery interventions.
How is a cardiac cath coded and billed?
The codes depend on which chambers and vessels were studied and whether a combined study was done. The indication in the note supports medical necessity.
How does billing change when a diagnostic cath becomes PCI?
If a study was done before the procedure, angiography is bundled into the PCI code. If the diagnostic study is the basis for the decision to treat, it may be reported separately. The note must show which applies.
Why can one cath produce two claims?
The physician bills a professional claim for performing and reading the study. The hospital or surgery center bills a facility claim for the room, staff, supplies, and devices. An office-based lab can bill both.
Do cath procedures need prior authorization in Texas?
It depends on the payer and the plan. Medicare Advantage and commercial plans often require approval for scheduled procedures, and each Texas Medicaid plan sets its own rules.
Why do cath lab claims get denied?
The usual causes are missing authorizations, diagnosis codes that do not support necessity, absent modifiers, bundled code pairs, and thin procedure notes.
How does A/R follow-up work for unpaid cath claims?
We work balances by payer and age, and flag late payments on state-regulated plans against the 30-day electronic clean claim window.
Bring us your cath billing
Contact Cardialogy Billing to discuss cath lab claims, denial patterns, and the authorization process, and to see how our team would take on the work.