The biggest challenge in running a successful health care firm is fighting the relentless obstacle of adapting to shifting regulations. For cardiology practices, the relentlessness of annual medical billing and coding updates is an actual nightmare for most.
For instance, in 2025, the new regulations are not a tweak; they represent a wholesale shift in the way cardiologists will have to document, code, and bill for services. For those practices that have long relied on in-house billers, it is now more than an administrative annoyance. It is, in fact, a full-blown financial risk if you do not have the right billing team by your side.
The 2025 Cardiology Billing Shake-Up
Do you know that the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) launched a set of 2025 updates that reflect the fast-paced innovation in cardiac care? It is often seen that many cardiology billers tend to miss out on these at times. These changes are not so much about adding new codes as they are about redefining how new technologies and care models are recognized and reimbursed.
New CPT Codes for New Technologies
It is often seen there’s the addition of new Category III CPT codes frequently. Though there are temporary codes for new services and procedures that are innovative and undergoing clinical evaluation. With the introduction of these codes, the AMA provides the means for collecting data on new procedures, which can subsequently lead to the creation of permanent, more highly reimbursed codes. And for cardiologists, staying on top of this curve is crucial for all these to know for billing revenue on new services.
In fact, for 2025, the new codes for certain of these new services are:
Use of drug-coated balloons with intravascular imaging: This is an evolution away from traditional stenting in some cases, and the new codes facilitate proper billing for combined procedure.
Robotically assisted cardiac surgery: With more robotics taking their place in such complex procedures as coronary artery bypass grafting (CABG), such codes are necessary to report and bill for the use of such sophisticated technology.
Cardiac Contractility Modulation-Defibrillator (CCM-D) systems: To manage heart failure, these new codes specify the implantation and treatment of these multi-purpose devices.
All about Update to ICD-10-CM and CCTA Reimbursement
The 2025 revisions also include more specific ICD-10-CM codes. This provides additional specificity to a patient’s diagnosis. For instance, new, more specific codes for heart failure with preserved ejection fraction (HFpEF) and multiple subtypes of atrial fibrillation (AFib) are among them. Specificity is important here as incorrect or non-specific diagnosis coding can lead to a claim denial even if the CPT code is correct.
As part of an attempt to more closely align payment with the actual cost of care, CMS also temporarily changed coronary CT angiography (CCTA) codes (75572-75574). They’ve been moved to a higher Ambulatory Payment Classification (APC), which should increase payment. It encourages use of an identifying cardiology revenue code, which better identifies the high cost of performing these procedures.
The Hidden In-House Billing Costs?
Most cardiology practices have had an in-house billing system in place for years, finding it more manageable. However, with the cyclical dynamics of an ever-changing industry, the model is obsolete. An in-house staff is plagued by numerous problems that cut into the practice’s bottom line point-blank:
Knowledge Gaps and Blunders: The volume of annual updates is so high that it is virtually impossible for an in-house staff of moderate size to stay current. A misplaced memo or misused modifier creates a denial of claim, and then it takes time and effort to reverse. These billing errors are typically a nuisance; they are a financial blow to the bottom line.
Risk of Audits and Penalties: The worst that can befall to improper billing is a payer audit, resulting in massive penalties and in extreme scenarios, fraud charges. To a cardiologist, it’s not just a financial loss—it’s a threat to his reputation and professional standing.
High Overhead Costs: The actual price of an in-house biller goes far beyond their salary. Practices must also include benefits, training, office space, equipment, and expensive billing software licenses. When a biller quits, the practice has to suffer through the expensive and labor-intensive recruiting and onboarding process.
The Strategic Advantage of Outsourcing
This increasing sophistication is a major reason that increasingly more cardiology practices are seeking to outsource as a strategic option. Outsourcing medical billing is not surrendering control; it’s outsourcing a complicated, specialized process to professionals who make it their career to remain current.
- Maximized Revenue and Faster Reimbursements – An outsourced cardiology billing company lives and breathes the codes and guidelines. Their model depends on whether they can get claims in clean the first time. Such proficiency yields.
- Fewer Denials – A specialized billing staff has a higher first-pass rate of claim acceptance, usually over 95%. That means fewer denials and thereby, much faster cash flow for the practice.
- Aggressive Follow-Up – Outsourcing companies employ specialized personnel who only follow up on denied claims and accounts receivable. Aggressive follow-up ensures that practices collect every dollar they’ve earned.
- Masterful Management of Challenging Cases – From electrophysiology to interventional cardiology, a billing company’s personnel are seasoned enough to handle the most difficult billing scenarios, such as the new codes for robotic-assisted and TAVR cases.
- Significant Cost Savings – While an outsourced service comes with a cost, the financial benefits usually far outweigh the cost. Practices can save money in a variety of key areas, like:
- Lower overhead cost for you – Eliminate the cost of salaries, benefits, and training when you have an in-house personnel. No more do you need to factor in software licenses, supplies, or IT assistance for your billing office.
- Scalability – If your practice is expanding or has volume fluctuations during seasonal times, an outsourced partner like SunKnowledge can come to the rescue. You can scale up or down services to meet your needs without the burden of hiring and firing staff.
- Predictable Expenses: In short, outsourcing expenses will typically be a percentage of collections, so you pay only upon receipt of payment. This predictability in expenses lowers budgetary pressure in your practice.
A New Era for Cardiology Billing
The 2025 changes to billing are a definite signpost: the “set it and forget it” days of billing are over. In the current competitive health care landscape, economic health for a cardiology practice is directly linked to the adequacy and efficiency of its billing and coding. For cardiologist like you where the patient is paramount, and giving excellent care is the top priority can come as a boon.
So by opting for a professional cardiology billing company like SunKnowledge, practices are not simply patching a problem; they are gaining a strategic advantage. As this allows them to drop the administrative burden, avoid financial risk, and give a healthy revenue stream that too as low as $7/hour while continuing their emphasis on the cutting-edge patient care. So if you are someone looking for a seamless billing transaction that can make a difference in today’s competitive era, outsourcing is the answer.
