Cardiology billing is a game of components and bundles. Diagnostic tests have professional (26) and technical (TC) portions that must be billed to the correct entity; echocardiography and stress-test codes carry NCCI edit pairs that deny when combined incorrectly; and every catheterization sits inside a 90-day global surgical period that swallows unrelated follow-up E/M claims unless modifier logic is right.
Start with the component split. A practice that owns its equipment bills the global code (e.g., 93306 for a complete echocardiogram) or splits it: 93306-26 for the physician interpretation and 93306-TC for the facility technical component. Billing both components when the practice only performed the interpretation is one of the fastest routes to a recoupment letter — and it is entirely preventable with charge-capture rules built into your EHR templates.
Bundling is the second leak. Complete echocardiography (93306) already includes the limited study (93307) and Doppler measurements; pairs like 93306 + 93307 deny under NCCI Procedure-to-Procedure edits unless the documentation supports a separately reportable service. Stress testing follows the same pattern: 93015 is the global stress-test code, while 93016–93018 bill the components for hospital or supervising-physician arrangements.
Finally, global periods. A 93458 left heart catheterization opens a 90-day global period during which routine post-procedure E/M visits are included, not separately billable. The exception engine is modifier logic: a visit for a distinct new problem usually requires modifier 24, and it requires documented diagnosis support. Our coders maintain payer-specific rulebooks for every service line a cardiology practice bills, so components, bundles and globals stop being revenue surprises.
“48% of leaders named denials and appeals their practice’s largest source of revenue leakage, compared with 23% who cited front-end issues.”