Client: Multi-Location Cardiology Group | 20+ Providers
Location: Midwest, USA
Service Line: Invasive & Non-Invasive Cardiology, EP Studies, Device Implants
Focus Area: Coding Optimization | Denial Reduction | Revenue Recovery
The Challenge
This established multispecialty cardiology group was experiencing substantial revenue leakage due to inconsistent coding practices and limited internal resources. The challenges included:
- Denial rates between 15–18%, primarily related to CPT/ICD mismatches
- Underutilization of high-complexity procedure codes such as 93656 (Ablation), 93458 (Cardiac catheterization), and 33249 (ICD implant)
- Incorrect or inconsistent modifier use resulting in bundled payments or claim denials
- Delays in coding turnaround time affecting timely claim submission
- Inadequate documentation support for coded services, increasing audit risk
- Limited training and awareness among providers on evolving payer requirements
- The internal coding team, while experienced, was overwhelmed by the growing complexity of cardiovascular procedures and payer-specific coding policies.
The Solution:
AnnexMed was engaged to lead a coding-focused revenue cycle intervention with the goal of improving accuracy, compliance, and overall financial performance.
Phase 1: Baseline Audit and Opportunity Mapping
AnnexMed conducted a comprehensive audit of 90 days of billed encounters. Key gaps identified included:
- Missed add-on and bilateral procedure codes
- Inconsistent coding of diagnostic services like Holter monitoring (93224) and stress tests (93015)
- Downcoded E/M levels due to vague or incomplete documentation
- Frequent misuse of modifiers, especially 59 and 25
Phase 2: Certified Cardiology Coders Deployed
A specialized team of AAPC-certified coders with cardiology expertise was assigned to the account. Key interventions included:
- End-to-end coding for both professional and technical components
- Real-time documentation review with physician queries for clarification
- Daily QA audits of high-risk codes and modifiers
- Establishment of a 24-hour coding turnaround benchmark
Phase 3: Documentation Education and Compliance Support
The coding team conducted regular training sessions with physicians to improve documentation quality. These sessions focused on:
- Accurately capturing medical necessity
- Supporting higher-level E/M and procedure codes
- Reducing audit risk through precise clinical language
- Clarifying when and how to use modifiers appropriately
Additionally, a compliance-ready workflow was implemented with proper traceability and audit support documentation.
Results
- 18% increase in monthly collections, driven by accurate CPT and modifier usage
- Coding-related denial rate reduced from 15.4% to 6% within 60 days
- Coding turnaround time improved by 70%, accelerating cash flow
- 100% of high-risk procedure charts fully defensible for audits
Revenue from device and EP procedures increased by 20%, due to appropriate usage of codes such as 93296, 93656, and 33249
Provider Feedback
“Before AnnexMed, we were constantly writing off denials that we thought were just part of the process. Now, we know what correct coding looks like. Our revenue is up, and we’re no longer afraid of audits.”
— Director of Revenue Cycle, Cardiology Group
