Services
Medical coding & compliance
Coding sits between what you did and what you get paid. Done well it is invisible. Done badly it shows up twice: once as denials, and again as audit risk.
Two failure modes, not one
Under-coding is the quiet one. The visit is documented thoroughly, the work was genuinely done, and the claim goes out at a level that does not reflect it. Nothing is denied, nothing is flagged, and the practice simply earns less than it should have. It rarely gets noticed because nothing looks wrong.
Over-coding is the loud one. It raises revenue until a payer notices the pattern, and then it brings a records request, a recoupment, and sometimes an extrapolated repayment across a sample period. Neither failure is acceptable, and they are not opposites you trade between. They are both symptoms of coding that is not anchored to documentation.
What we do
- CPT, ICD-10-CM and HCPCS assignment against the chart, not against a superbill habit or last year's template.
- Modifier discipline. 25, 59 and the X-series get scrutiny because payers scrutinise them. Applied where the documentation supports it, left off where it does not.
- HCC and risk-adjustment capture for practices in value-based arrangements, where an unrecorded chronic condition silently lowers the risk score for the whole year.
- Internal audits on a rolling sample, with findings written up against the documentation so they are useful to the clinician rather than just a score.
- Documentation feedback to providers in plain language. The goal is fewer queries next quarter, not a longer list of corrections.
- Payer policy tracking. Coverage rules, LCD and NCD changes and bundling edits change constantly, and a code that paid last quarter may not this one.
Compliance is the point
The test of a coding operation is not its approval rate. It is whether, if a payer asked you to produce the documentation behind a sample of claims, you could do it without worrying. That is the standard we work to, and it is why we will tell you when a chart does not support the level you expected.
Our coders are AAPC-certified and work within a signed Business Associate Agreement. Coding questions about a specific patient encounter are handled by the team against the chart, never through the website chat.
Common questions
Do you code from the chart or from what we send?
From the chart. Coding from a superbill means coding from somebody else’s conclusion, which carries their errors forward and leaves you holding the compliance risk.
What happens if documentation does not support the code?
You get a query, not a quiet downgrade and not an optimistic submission. If the work was done and simply is not written down, that is fixable at the documentation stage. If it was not done, the code does not go out.
Can you help if we are already under audit?
We can code correctly going forward and help you understand what the records show. Responding to a payer audit or a recoupment demand is legal territory. Talk to a healthcare attorney, and we will work alongside them.
Start with the free audit
Send us ninety days of claims data and we will show you what was left uncollected. No charge, no obligation, and the findings are yours either way.
Request my free audit