Medical Coding & Audits
Coding decides what you are paid — and what you can defend.
A missed modifier costs you a claim. A drifting E/M level costs you either revenue or an audit finding, depending on which direction it drifts. MBS treats coding as a controlled process: audit the documentation first, code what the record supports, catch the edits before submission, and take the findings back to the provider.
Certified coders, matched to the specialty they code every day.
Documentation audit before any coding change is recommended.
Findings returned to providers, not just corrected quietly.
THE PROCESS
Five steps, audit first
The order matters. Coding changes made before an audit are guesses; coding changes made after one are evidence-based, and they can be measured on re-audit.
Baseline audit on your own charts
We start with a sample of your documentation and the codes that were billed against it, per provider. That gives an accuracy picture with evidence behind it instead of an opinion about how your coding feels.
- Sample selected across providers, visit types, and payers
- Each chart scored for code accuracy, level support, and modifier use
- Under-coding flagged as clearly as over-coding
Worth knowing
Under-coding is the finding practices least expect. Defensive E/M levelling is common and quietly costs more than the occasional over-code it was meant to avoid.
Code to the documentation, not to the habit
Production coding is assigned to coders credentialed in the relevant specialty. The code set follows what the note supports — and when the note does not support the service, that is a query, not a guess.
- ICD-10-CM, CPT, and HCPCS assigned from the record
- Provider queries raised where documentation is incomplete
- Specialty rules applied: time-based units, global periods, bilateral and add-on codes
Worth knowing
A coder who works one specialty all day catches the pattern a generalist has to look up. That is why coders are matched by specialty rather than by availability.
Edits and bundling reviewed before submission
Modifier and bundling errors are among the most repeatable denial causes in outpatient billing, and they are almost entirely preventable at this stage.
- NCCI and payer-specific edits checked pre-submission
- Modifier 25, 59, and the X-modifier family applied with documentation support
- Unbundling and mutually exclusive pairs caught before the payer catches them
Worth knowing
The same edit failing every month is a rule problem, not a coder problem. Confirmed patterns become scrubber rules so the fix outlives the individual claim.
Quality review and audit trail
A share of coded encounters goes through second-level review, and every coding decision keeps its rationale, so a payer audit or an internal compliance review has a record to read.
- Second-level review sampling with results tracked per coder
- Rationale retained for judgment calls and unusual code combinations
- Compliance posture aligned to your policies and payer requirements
Worth knowing
Coding is only defensible if the reasoning survives the staff member. Documented rationale is what turns accuracy into something auditable.
Provider education loop
Corrections that never reach the provider get repeated forever. Recurring findings come back as short, specific feedback tied to real charts — not a generic coding webinar.
- Per-provider findings summarized in plain language
- Documentation templates and prompts adjusted where they cause the gap
- Re-audit after the change so improvement is measured, not assumed
Worth knowing
This is the step that compounds. A documentation prompt fixed once removes a recurring denial and a recurring correction at the same time.
98.2%
First-pass clean claim rate
trailing 12 months, all clients
60+
EHR / PM integrations
we work inside the system you already use
SOC 2
Type 2 audited, HIPAA compliant
report available under NDA
Coding rules that change by specialty
A coder assigned to the wrong specialty is technically correct and practically expensive. These are the differences that decide accuracy.
Behavioral health & SUD
Time-based units, group versus individual sessions, level-of-care transitions, and the documentation payers actually read on medical necessity.
Surgical & procedural
Global periods, staged and bilateral procedures, assistant surgeon rules, and the modifier discipline those require.
Primary & chronic care
E/M levelling on the 2021+ framework, chronic care and remote monitoring codes, and preventive visits billed alongside problem-focused care.
Diagnostics & ancillary
Professional and technical component splits, medical-necessity linkage on imaging, and therapy unit rules.
See how the billing model differs by specialty group.
WHAT YOU GET
Included in a coding engagement
- Certified specialty coding for professional services
- ICD-10-CM, CPT, and HCPCS assignment
- Baseline and periodic documentation audits
- Modifier, bundling, and NCCI edit review
- Provider query workflow
- Second-level quality review sampling
- Per-provider accuracy reporting
- Provider education and template feedback
- Coding support for denial appeals
- Work performed inside your existing EHR/PM
Tailored to you, with clear boundaries
Specialty mix, review depth, audit volume, and reporting are all built around your practice. A few things stay with your team, and we say so up front:
- Clinical decisions about the care delivered — coding follows the record, never rewrites it
- Signing or amending provider documentation on a provider's behalf
- Legal or regulatory opinions; compliance counsel stays with your advisors
Coding questions, answered honestly
Can we buy coding without billing?
Yes. Coding is offered as a standalone scope, and plenty of practices keep their billing in-house or with another vendor while using us for coding and audits. It also pairs naturally with billing, since coding accuracy is where a large share of first-pass rate is decided.
Are your coders certified?
Yes, and they are assigned by specialty rather than by whoever is free. Second-level review sampling is part of the workflow, with results tracked per coder rather than as a single team-wide figure.
What does a coding audit actually produce?
A scored sample by provider and visit type, the specific charts behind each finding, the financial direction of the error — under-coded, over-coded, or non-compliant — and a short list of documentation changes ranked by how often the issue appears.
Will an audit put us at risk if it finds problems?
Finding an issue internally is materially better than a payer finding it. We report findings to you, including under-coding and over-coding, and let you decide with your compliance advisors how any correction is handled. We do not make that call for you.
How do you handle incomplete documentation?
With a provider query. We do not upcode to what was probably done, and we do not silently downcode a supportable service. Both create risk, in opposite directions.
Do you code inside our system?
Yes. Coders work in your EHR/PM so the coded encounter, the query history, and the audit trail stay in your record and remain available after the engagement.
Where coding connects
Denial Management & Appeals
Coding and modifier errors are a leading denial cause — this is where the pattern gets closed out.
Medical Billing
Submission, posting, and follow-up once the coding is right.
CPT & code reference
Working notes on frequently billed codes, documentation requirements, and common edits.
Start with an audit, not a proposal
Give us a sample of charts and the codes billed against them. You get a scored finding per provider — including where you are leaving money on the table — before any engagement is scoped.
How does your A/R and denial rate compare?
Free benchmark tool — enter six numbers, see your bands against published industry sources, and download a branded PDF.