Adult Congenital Heart Disease EHR and AI Medical Billing Software

Adults born with heart defects need lifelong specialist care built on decades of history. XEHR keeps the surgical past, imaging and present care in one record.

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Chart · Office visit

Lastname, Firstname M. Sample patient · DOB 01/01/1980 · Commercial

Eligible

BP128/82

HR72

BMI26.4

Temp98.6

Progress noteAI Scribe draft

Repaired tetralogy of Fallot; routine annual review.

Q21.3 Tetralogy of Fallot

ReviewSign note

Diagnosis carried to the claimQ21.3

THE HARD PARTS

What makes adult congenital heart disease billing hard

A history that starts at birth

Earlier repairs, operations and reports often come from children’s hospitals and have to be found before each decision.

Imaging on long intervals

Echocardiograms and cardiac MRI follow schedules set by the defect and the repair, and payers ask why each one was done.

Life events that change the plan

Pregnancy, exercise and new rhythm problems each need planning across several specialists.

WHERE THE WORK HAPPENS

How adult congenital heart disease care is delivered and billed

Adult congenital heart disease care happens in specialist programs, usually connected to a hospital with congenital cardiac surgery. Clinic visits, echocardiogram and MRI interpretations and exercise testing are billed on the professional claim; catheterizations and surgery are done in the hospital. Patients transfer from pediatric cardiology in their late teens, so records from children’s hospitals are a large part of the chart.

What payers check on adult congenital heart disease claims

Congenital defects are coded with congenital anomaly codes for life, even after repair, with status codes for the repair where they apply.
Advanced cardiac imaging usually requires prior authorization with documented anatomy and the reason for the interval.
Interpretations are billed only for studies the physician actually read and documented.
Pregnancy in patients with heart disease is coded with obstetric codes first when the obstetric care is the reason for the visit.
Hospital procedures are billed with the hospital place of service and follow global period rules.

Common adult congenital heart disease diagnoses ICD-10-CM

Q21.3	Tetralogy of Fallot
Q21.10	Atrial septal defect, unspecified
Q25.1	Coarctation of aorta
Q20.5	Discordant atrioventricular connection
Q23.1	Congenital insufficiency of aortic valve
Z87.74	Personal history of (corrected) congenital malformations of heart and circulatory system

Examples only. The provider chooses the code that matches the documented diagnosis, and XEHR checks it against the note and the payer's rules before the claim goes out.

A VISIT ON XEHR

An adult congenital heart disease visit, start to payment

1
Bring the history in

Operative reports and earlier imaging are filed and summarized before the first visit.
2
Assess and plan

The note documents the defect, repairs, current function and the surveillance plan, with the AI drafting for review.
3
Order imaging with its reason

Echocardiograms and MRI are ordered with the anatomy that justifies them; approvals are prepared where needed.
4
Coordinate and bill

Referrals go to the other specialists from the chart, and visits and interpretations go out on checked claims.

How XEHR helps

From the adult congenital heart disease visit to the payment

Surgical history kept with the patientEarlier repairs and outside records are filed to the chart and summarized for the next visit.
Imaging with its reasonEach study is ordered with the defect and repair that justify it, which supports approval.
Shared care made easyReferrals and notes to obstetrics, electrophysiology and surgery go from the same record.
AI that waits for youThe AI drafts notes and prepares claims; your providers sign and your billers approve.

Claim · CMS-1500

Sample claimLastname, Firstname M. · DOS 03/04/2026

Scrub passed

Scrubbed
Submitted
Accepted
Paid

Service	Dx	Units	Charge
Office visit	E11.9	1	145.00
A1c test	E11.9	1	28.00
Total			173.00

ERA postedPayment applied, no re-keying

Agentic AI for adult congenital heart disease

AI medical billing for adult congenital heart disease practices

XEHR is an agentic EHR: AI agents do the administrative work around every adult congenital heart disease visit, and your team approves what matters. How agentic AI works

Before the claim leaves

The claim-check agent looks for

Congenital defects are coded with congenital anomaly codes for life, even after repair, with status codes for the repair where they apply.
Advanced cardiac imaging usually requires prior authorization with documented anatomy and the reason for the interval.
Interpretations are billed only for studies the physician actually read and documented.
Pregnancy in patients with heart disease is coded with obstetric codes first when the obstetric care is the reason for the visit.

Around the visit

Agents run on their own

Coverage checked before each adult congenital heart disease visit
The visit note drafted for the provider to sign
Insurance payments matched and posted
Open claims tracked, denials read and appeals drafted

People decide

Your team stays in charge

Providers sign every note
Billers approve every claim and appeal
Staff submit prior authorizations
Any check can be overridden, with a reason

BUYER'S GUIDE

Questions to ask before you choose an adult congenital heart disease EHR

Ask every vendor, including us. The answers show whether a system was built for adult congenital heart disease work or only adapted to it.

Ask us on a demo

Can operative reports from children’s hospitals be filed and summarized in the chart?
Does the system keep congenital codes consistent for life, with repair status?
Is advanced imaging ordered with the anatomy that justifies it for approval?
Can referrals to obstetrics, electrophysiology and surgery be sent from the same record?
Can the surveillance plan be recorded so studies are due on time?

QUESTIONS

Adult Congenital Heart Disease practices ask us

Does XEHR suit adult congenital heart programs?

Yes. Lifelong history, imaging and multidisciplinary care are documented in one record.

Can outside records from childhood be kept in XEHR?

Yes. Outside reports are filed to the patient record and remain available at every visit.

Does XEHR help with cardiac MRI approvals?

Yes. Imaging that needs prior authorization is flagged and the request is prepared with the defect and repair history.

Can XEHR support pregnancy planning for these patients?

Yes. Shared notes and referrals with maternal-fetal medicine are sent and tracked from the same chart.

Does XEHR support patients moving from pediatric to adult care?

Yes. The full history stays in one record when care transfers.

Can XEHR record exercise test results?

Yes. Results are filed and interpreted in the patient record.

Does XEHR handle pregnancy planning for heart patients?

Yes. Shared notes and referrals with maternal-fetal medicine are tracked.

How much does XEHR cost for an adult congenital heart disease practice?

Pricing is published: $189 per provider per month for the Clinical plan, $449 per provider per month for the Practice Suite with billing, or 2.5% of collections for RCM as a Service. Month-to-month, with a BAA on every plan. See pricing.

How long does it take an adult congenital heart disease practice to go live?

Small practices are usually live in 2 to 4 weeks, including setup, data migration and training. We agree the plan with you before you sign.

Related specialties

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See XEHR set up for adult congenital heart disease

A 30-minute walkthrough on a live test environment, with your specialty's templates and billing.

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