Medical Coding Services
Certified coders who read the note, not just the superbill.
Coding is where most denials are born and where most underpayment hides. A claim coded at a lower level than the documentation supports gets paid, so nobody flags it. That is the expensive kind of error, because it never shows up as a denial.
Our coders are AAPC-certified and work by specialty rather than rotating across everything. They read the clinical documentation, assign codes to what was actually done, and flag notes that will not support the level billed.
The problem
Where this usually goes wrong
Undercoding nobody notices
A 99213 billed where the documentation supported a 99214 pays cleanly. Multiply the difference across a year of visits and it is a serious number, invisible in every report you run.
Modifier errors
Modifier 25, 59 and the X-series are the most common source of specialty denials. Payers have tightened enforcement and rules differ between them.
Documentation gaps found too late
If the note does not support the code, you find out at appeal or at audit. Both are expensive. Both are avoidable at the point of coding.
What is included
- CPT, ICD-10-CM and HCPCS Level II assignment
- E/M level review against 2021+ documentation guidelines
- Modifier assignment and payer-specific modifier rules
- NCCI edit and bundling checks before submission
- Documentation queries back to the provider when a note will not support the code
- Specialty-specific coding by coders who work that specialty
- Retrospective coding audits with a written findings report
- Provider education on the patterns we keep seeing in your notes
How it runs
Our process
- 1
Baseline audit
We code a sample of your recent encounters independently and compare against what was billed. That comparison tells you your current accuracy rate and where the money is going.
- 2
Documentation review
We look at your templates and note structure. A lot of coding problems are template problems, and fixing the template fixes them permanently.
- 3
Daily coding
Encounters coded within one business day of the note being signed. Queries go back to the provider the same day rather than holding the claim.
- 4
Pre-submission scrubbing
NCCI edits, modifier logic and payer-specific rules checked before the claim leaves. Catching it here costs nothing. Catching it at denial costs a rework cycle.
- 5
Quarterly accuracy review
A sample of our own coding re-audited, with the results shared with you. If our accuracy slips you should hear it from us first.
Questions we get asked
Are your coders certified?
Yes. Our coders hold AAPC certification (CPC or specialty equivalents) and are assigned by specialty rather than rotated across all of them. Specialty familiarity is what catches the modifier and bundling traps.
Can you code from the note, or do you need a superbill?
We code from clinical documentation. Coding from a superbill means coding from what the provider remembered to tick, which is exactly where undercoding comes from.
What happens when documentation does not support the code?
We query the provider the same day with a specific question about what is missing. We do not code to a level the note will not support, and we do not sit on the claim without telling you.
Do you handle coding audits?
Yes, both retrospective audits of your existing coding and support if a payer audits you. The retrospective audit is usually where practices find out what their real accuracy rate is.
Can we use coding only, without full billing?
Yes. Coding is available as a standalone service if you have billing handled and only want the coding piece taken off your plate.
How do you stay current with code changes?
Annual CPT and ICD-10 updates are applied before their effective dates, and payer-specific policy changes are tracked as part of the service. This is the part practices most often fall behind on.
Related services
See what your practice is leaving on the table.
We look at 90 days of your claims data and tell you what is recoverable. No cost, no obligation, BAA signed before anything changes hands.
- Recoverable dollars in your aged A/R, as a number
- Denials grouped by root cause, ranked by value
- A written summary you keep either way
Prefer to talk? (301) 786-0552
Or email info@asesormd.com