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Top Reasons for Cardiology Claim Denials
1. Incorrect or Missing Modifiers
Cardiology procedures often require specific modifiers (e.g., 26, TC, 59, -XS) to indicate whether the technical or professional component was performed. Missing or misused modifiers can lead to automatic denials.
2. Inaccurate CPT/ICD-10 Codes
Cardiology involves complex coding, and mismatched or outdated codes can result in rejections. For example, pairing a diagnostic CPT code with a non-supportive diagnosis code can trigger denials.
3. Lack of Medical Necessity
If a payer determines that a test or procedure wasn't medically necessary (according to their guidelines), the claim will be denied. This often happens with stress tests, echocardiograms, and cardiac catheterizations if documentation is insufficient.
AnnexMed specializes in cardiology billing and proactively addresses these denial triggers by:
• Using certified coders who understand specialty-specific nuances
• Automating eligibility checks and authorization tracking
• Ensuring accurate documentation and charge capture
• Managing denials with rapid follow-up and appeals
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