Medical Coding
Diagnosis and procedure codes that match the documentation.
Coding turns what happened in a visit into ICD-10-CM diagnoses, CPT procedures and HCPCS supplies that a payer will accept. We review and assign codes against the documentation, query the clinician when a note does not support a code, and code to the encounter rather than to a target reimbursement.
Tools we work in
- ICD-10-CM
- CPT
- HCPCS Level II
- EncoderPro
- athenahealth
- eClinicalWorks
Scope
What this covers
The specific work included when you engage us for this service.
- ICD-10-CM diagnosis coding taken from the clinical note
- CPT and HCPCS Level II procedure and supply coding
- Modifier application and review, since a missing or wrong modifier is a common denial cause
- Evaluation and management level review against documented medical decision making
- Coding queries sent back to the clinician when the note does not support the code
- Payer-specific coding policy checks before the claim is submitted
- Audit of a random sample of existing claims, with findings written up for your review
What you receive
- 01Coded encounters with the documentation that supports each code attached
- 02A query log showing where documentation was insufficient and what was asked
- 03An audit summary by provider and code family, kept internal to your practice
Questions
Medical Coding, answered
Can you guarantee a clean claim rate?
No. A claim is ultimately clean only when the payer accepts it and the documentation supports every code on it, and the payer decides that, not us. What we control is reviewing codes against the note before submission and correcting what does not hold up. Anyone promising a specific clean claim percentage is promising an outcome that belongs to the payer.
Who is responsible for a coding error?
The provider signs the claim, so coding accuracy stays a shared responsibility between the coder and the clinician. That is exactly why we send queries back rather than guessing: if the note does not document a condition, we do not code it. We also keep a written record of every query and how it was resolved, so there is a trace if a payer ever asks.
Will you code to the highest level the note could possibly support?
We code to what the documentation supports, and no further. Upcoding invites audits, repayment demands and in the worst case a fraud investigation, and it is not a trade we will make on your behalf. Where a note genuinely supports a higher level, we will code it and show the reasoning so you can see the basis for it.
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Tell us where the manual work is
A 30-minute call. We map the process, tell you what we would automate or build first, and what it costs. No retainer before you agree the scope.
- No retainer before scope is agreed
- Written plan you can act on alone
- Worldwide delivery, on your hours