Medical coding and coding quality
Coding that matches the documentation — and holds up later
Medical coding translates what was documented in a visit into ICD-10-CM diagnosis codes, CPT and HCPCS procedure codes and modifiers. Accurate coding is what allows a claim to be paid correctly and defended if it is ever reviewed. Our coders work from your documentation, query providers when the record is unclear, and never code what was not documented.
Does this sound familiar?
- Denials for medical necessity or invalid code combinations keep repeating.
- Providers are unsure whether they are under- or over-coding E/M visits.
- Modifiers are applied inconsistently across providers.
- There has never been an outside look at coding patterns.
Scope of work
Exactly what this service covers — and what it doesn't — so responsibilities are clear before you sign anything.
Included
- Professional (outpatient) coding from provider documentation
- ICD-10-CM, CPT and HCPCS Level II code assignment and modifier review
- Code-edit resolution, including National Correct Coding Initiative (NCCI) edits
- Provider documentation queries when the record does not support a code
- Periodic coding reviews with findings shared by provider
- Feedback on documentation patterns that drive denials
Not included
- Assigning codes that are not supported by documentation
- Altering or authoring clinical documentation
- Inpatient facility (DRG) coding
- Legal or regulatory audit defense — we support your counsel with records if needed
How the work flows
- 01
Documentation received
Signed notes are pulled from your EHR or shared through your system's secure workflow.
- 02
Code assignment
Diagnosis, procedure and modifier codes are assigned against the documentation and payer policy.
- 03
Edit check
Code pairs are checked for bundling and medically unlikely edits before the claim is built.
- 04
Query if unclear
If documentation is incomplete, the provider receives a specific, non-leading query.
- 05
Review cycle
A sample of encounters is reviewed periodically, with results shared by provider.
What we measure
Measured against your own baseline. We don't quote benchmarks or other clients' results.
- Coding-related denial rate
- Denials attributed to coding or modifier issues as a share of all claims.
- Query turnaround
- Time between a documentation query and the provider's response.
- Review findings
- Number and type of discrepancies found in periodic coding reviews.
What we need from your practice
- Read access to signed clinical notes
- A provider contact for documentation queries
- Your current superbill or charge master
- Patient information is exchanged only through secure access you control — never through forms or email on this website.
Specialties this service supports
Medical coding and coding quality: common questions
Are your coders certified?
We will share the credentials of the team assigned to your account during the consultation. We do not list certifications on this website until they are verified for each team member.
Will you change what our providers selected?
If documentation supports a different code, we explain why and confirm with the provider before the claim is submitted. Final documentation is always the provider's.
Can you only do a coding review, without billing?
Yes. A standalone coding review can be scoped as a project. It is a good way to see how we work before deciding on full-service billing.
Related services
- End-to-end medical billingCharge entry through payment — claims built, scrubbed, submitted and followed until resolved.
- Denial prevention and appealsFront-end checks, denial categorization, appeals and trend reporting to stop repeat denials.
- Eligibility, benefits and prior authorizationCoverage checks, benefit summaries and authorization tracking before the visit.
Primary sources
Content last reviewed . Payer rules change; this page is general information, not legal or coding advice for a specific claim.
Talk to us about medical coding and coding quality
Tell us where payments are getting stuck. In 20 to 30 minutes we'll show you what we'd check first, and tell you plainly if we can help.
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