Catch the coding gap before the claim drops
Our AAPC-certified coders review charts before billing and coach providers on what to document, so the E/M level, the diagnosis specificity and the modifiers still hold up when a payer or an auditor looks.
Pre-Bill Coding Validation
We review encounters before release, all of them for high-risk services and a sample for the rest, and correct codes, modifiers and units while the claim is still yours to fix.
E/M Level and Modifier Review
Level selection, modifier 25, 59 and the X modifiers, 24 and 57. We check that the note supports the level and the modifier, not just that the code is valid.
Diagnosis Specificity and Medical Necessity
We link each service to the most specific diagnosis the record supports and check it against the payer policy that decides whether the claim pays.
Provider Documentation Feedback
Short, specialty-specific feedback built from your own notes. No lectures. Each provider sees two or three real examples and a simple template change.
AI-Assisted Chart Screening
Software reads charts first and flags gaps for review. A certified coder makes every final call, and nothing is auto-submitted on a machine suggestion.
Audit-Ready Reporting
Error rates by provider and code family, trends over time, and dated follow-up audits, so you can show a payer or a compliance officer what you checked and when.
Baseline audit
We pull a sample of recent charts per provider and score them for level, modifiers, diagnosis specificity and medical necessity.
Findings review
We walk each provider through their own results, privately and with examples from their notes.
Pre-bill validation goes live
Charts route through review before release, with rules tuned to your specialty and top payers.
Feedback and template updates
Providers get a short summary, and we update templates and prompts where the same gap keeps showing up.
Re-audit
A fresh sample shows what changed, and the results stay on file.
- Practices with high E/M volume, where a small level shift repeats thousands of times a year
- Procedure-heavy specialties with modifier exposure
- Groups adding providers who bring different documentation habits
- Practices that received a payer audit letter or a records request
Related reading and services: Compliance & Auditing · Under-coding revenue loss · Medical coding audit guide · E/M coding 2026.
Coding errors start in the note, and they repeat
A single under-coded visit is a small leak. A provider who under-codes the same visit type 40 times a month is a steady one. A level shift of one step on high-volume E/M visits can be worth tens of thousands of dollars a year per provider, and the opposite error (over-coding) creates audit exposure that lasts for years.
That's why validation before the claim drops beats cleanup after. Once a claim is out, a wrong code is a denial, an appeal or, in the worst case, a repayment request. Before it's out, it's a two-minute fix and a short note to the provider.
Regulators look back further than most practices expect. Recovery audit contractors can review Medicare claims up to three years after payment, and overpayments that you identify must be reported and returned within 60 days. The cheapest time to find an error is before billing.
What a first 90 days looks like
- Week 1: Baseline auditWe pull a sample of recent charts per provider and score them for E/M level, modifiers, diagnosis specificity and medical necessity.
- Week 2: Private findings reviewEach provider sees their own results with examples from their own notes. No group scorecards, no shaming.
- Weeks 3 to 4: Pre-bill review goes liveHigh-risk services get 100% review before release; other encounters are sampled at a rate that fits your error rate.
- Month 2 and 3: Feedback and templatesShort provider summaries, plus template changes where the same gap keeps showing up.
- Quarter end: Re-auditA fresh sample shows what changed, and the results are kept on file in case a payer ever asks.
What coding validation costs
Coding validation is a standalone service, quoted individually after a short intake. The price depends on provider count, encounter volume and how many services need 100% review. It's also available without a billing contract.
If you're weighing it, start with the free assessment. We'll review a sample of your charts and tell you honestly whether pre-bill validation would pay for itself in your practice.
Questions we hear most
What's the difference between coding validation and CDI?
Validation checks that the codes match the documentation before billing. Clinical documentation improvement works on the note itself, so the next one supports a correct code without a query.
Do you change codes without asking the provider?
No. Where the note is unclear, the provider gets a short written query. Codes are changed only when the record supports the change, and every query is tracked to closure.
Does software make the final coding decisions?
No. Software flags gaps for review, and a certified coder makes every final call. Nothing is auto-submitted on a machine suggestion.
How long does a baseline audit take?
About a week from receiving charts. You get a written summary by provider and code family.
Related: Compliance and auditing · Medical coding services · Medical coding audit guide · Under-coding revenue loss.
Want a baseline coding audit of your own charts?
We'll review a sample, show you what the record supports, and tell you honestly whether pre-bill validation is worth it for your practice.
Start With a Free Assessment →