Medical Coding Audit Services

A coding audit examines the question underneath every claim: does the documentation support the code? The answer matters in both directions — overcoding creates payer audit and repayment exposure, while undercoding quietly donates earned revenue back to payers year after year. Most practices that have never audited find some of each.

Our coding audits sample encounters across providers and service types, validate code selection against documentation using current official guidelines, analyze E/M level distributions against specialty norms, and deliver findings as provider-specific education rather than a compliance scare memo.

Problems This Service Addresses

• Unknown exposure from coding patterns nobody has independently reviewed
• E/M distributions that look unusual against specialty norms
• Suspected undercoding by conservative providers
• Payer audit or prepayment review already underway or threatened

What’s Included

• Stratified encounter sampling across providers and visit types
• Documentation-to-code validation against current guidelines
• E/M level distribution analysis with specialty context
• Finding-by-finding provider education summaries
• Re-audit scheduling to verify pattern change

Who This Service Is For

• Practices that have never had an independent coding review
• Groups with notable E/M distribution variation between providers
• Practices responding to payer audit activity

Risks and Operational Considerations

Audit findings are educational and operational; they are not legal advice, and practices facing active payer audits or investigations should involve healthcare counsel — audits can sometimes be structured under privilege at counsel’s direction.

Where certified coder review is required for the audit scope, that staffing is stated explicitly in the engagement terms rather than assumed.