Coding decides what a visit is worth. Documentation that supports a higher level than the code applied loses the difference on every encounter, and because it never denies, nothing flags it.
We review codes against the documentation behind them, apply modifier and bundling rules per payer rather than by general habit, and report undercoding as readily as overcoding.
What's included
- Documentation reviewed against the code actually billed
- Modifier and bundling logic checked per payer, not per rule of thumb
- Undercoding flagged as well as overcoding
How it's handled
ICD-10, CPT and HCPCS reviewed against documentation, with modifier and bundling rules checked per payer.