What a coding review covers
Certified coders review a sample of your encounters against the provider documentation and current code-set guidelines. Every finding comes with the documentation reason behind it, so your team understands what to change.
- Diagnosis coding to the highest supported specificity (ICD-10-CM)
- Procedure and E/M level selection (CPT), including medical decision making and time-based coding
- HCPCS Level II codes for supplies, drugs and services
- Modifier use, including 25, 59 and the X{EPSU} modifiers
- NCCI edit and medically unlikely edit (MUE) conflicts
- Hierarchical condition category (HCC) capture for risk-adjusted contracts
Why it matters
Under-coding leaves earned revenue unbilled. Over-coding creates audit and repayment risk. A regular review keeps your coding accurate in both directions and gives you a measurable baseline to improve against.
What you receive
- An accuracy score by provider and by code category
- A findings report with the corrected code and the supporting documentation reference
- Estimated revenue impact of the errors found
- Practical recommendations for providers and billing staff
How it works
- Kick-off call to agree scope, specialties and sample size
- Secure, HIPAA-conscious transfer of de-identified or minimum-necessary records
- Review and findings report
- Results walkthrough with your team
Frequently Asked Questions
How many charts do you review?
Sample size depends on your number of providers and goals. A common starting point is 10 to 20 encounters per provider, which we agree with you before starting.
Do you review E/M levels?
Yes. We review E/M level selection using the current CPT guidelines based on medical decision making or total time on the date of the encounter.
Can you work with our EHR?
We work from records exported or shared from your system, so the review does not depend on a particular EHR vendor.