Medical coding services
Codes that match the note, modifiers checked against NCCI edits, and E/M levels supported by your documentation.
Coding errors cost money in both directions. Undercoding a moderate-complexity visit as a 99213 leaves revenue behind on every encounter. Overcoding, or adding modifier 25 without a separately identifiable service in the note, invites denials and payer audits. Most practices see both problems at once, usually in the same handful of codes.
SFA Solutions reviews each encounter before the claim is created. We confirm the E/M level against medical decision making or total time under the current AMA guidelines, check procedure and diagnosis pairs against NCCI edits and payer coverage policies, and assign ICD-10-CM codes to the highest supported specificity. When the documentation does not support a code, we send the provider a short query instead of guessing. We keep up with the annual ICD-10-CM update each October 1, the CPT update each January 1, and quarterly NCCI and HCPCS changes, so your claims reflect the code set in effect on the date of service.
Who this is for
Coding review suits practices whose providers code their own visits, groups with uneven E/M distribution between providers, and specialties where modifiers drive payment, such as dermatology, orthopedics, podiatry, cardiology, ophthalmology and pain management. It also helps practices preparing for a payer audit or responding to a records request.
Related services
What our medical coding service covers
E/M leveling
Office and outpatient visits (99202 to 99215) leveled by MDM or total time, with G2211 applied only where Medicare rules allow it.
Procedure coding
CPT and HCPCS coding for in-office procedures, injections, drugs and supplies, with correct units and NDC details where payers require them.
Modifier accuracy
Modifiers 25, 59, XE/XS/XP/XU, 26, TC, 50, LT/RT and 95 applied only when the documentation supports them.
ICD-10-CM specificity
Diagnoses coded to full specificity, including laterality, episode of care and complications, so medical necessity is clear.
Provider queries
Short, compliant questions to providers when the note is unclear, with answers documented before the claim goes out.
Coding feedback
A monthly summary of coding patterns by provider, with examples, so documentation improves over time.
How we deliver it
Baseline review
We code a sample of recent encounters and compare our results to what was billed, showing where codes were too high or too low.
Setup
We load specialty rules, payer coverage policies and your common code sets into our review checklist.
Daily coding
Encounters are typically coded or reviewed within one business day, so clean claims can stay on our 24-hour submission target after final review.
Monthly feedback
Providers get a short report on E/M distribution, modifier use and query trends, with documentation tips tied to real examples.
Codes and modifiers that cause the most coding errors
| Code or modifier | What it means | Common mistake |
|---|---|---|
| 99214 | Established patient office visit, moderate MDM or 30+ minutes total time | Billing by time without documenting the total minutes spent that day |
| Modifier 25 | Significant, separately identifiable E/M on the same day as a procedure | Appending it when the note only supports the procedure's own evaluation |
| Modifier 59 and X modifiers | Distinct procedural service, used to bypass NCCI procedure-to-procedure edits | Using 59 where XE, XS, XP or XU is more specific, or where no distinct service exists |
| G2211 | Medicare add-on for visit complexity in ongoing longitudinal care | Billing it with an E/M that carries modifier 25 outside the limited exceptions CMS allows |
| Modifiers 26 and TC | Professional and technical components of a diagnostic service | Billing the global code when the practice only performed one component |
| E11.9 vs. E11.65 | Type 2 diabetes without complications vs. with hyperglycemia | Defaulting to the unspecified code when the note supports a more specific one |
Medical Coding for your specialty
We bill for 28+ specialties. These are the ones we work with most.
Nurse Practitioner billing
Billing for NP-led and physician-NP practices, from the 85% Medicare rate and incident-to rules to split/shared visits and getting each NP credentialed under the right NPI.
Learn moreInternal Medicine billing
Billing for internists who manage complex, chronic patients, with E/M levels, wellness visits and care management codes captured when the documentation supports them.
Learn moreOphthalmology billing
Eye exam codes, refraction, diagnostic testing, cataract globals and high-cost injectable drugs all follow their own rules. Ophthalmology is one of the specialties we bill most often.
Learn moreQuestions about medical coding
Do you code from the provider's note or from the superbill?
From the note. A superbill is a useful starting point, but the documentation is what a payer reviews in an audit, so we confirm codes against what the provider actually wrote.
How are office E/M levels chosen now?
Since 2021, office and outpatient E/M codes are chosen by either medical decision making or total time spent by the billing provider on the date of the encounter. MDM looks at the number and complexity of problems, the data reviewed, and the risk of management. We use whichever method the note supports best.
When can G2211 be billed?
G2211 is a Medicare add-on for office and outpatient E/M visits when the provider is the continuing focal point for the patient's care or manages a serious or complex condition over time. It is generally not payable when the E/M carries modifier 25, although CMS allows it with modifier 25 in limited cases such as same-day preventive services. Commercial payer policies vary.
Will you change codes without asking the provider?
We correct clear clerical errors such as a missing laterality modifier. For anything that changes the level of service or the diagnosis, we send a query and wait for the provider's answer.
How do you stay current on code changes?
We update our rules for the ICD-10-CM release each October 1, the CPT release each January 1, and the quarterly NCCI and HCPCS updates, and we track coverage policy changes from Medicare contractors and major commercial payers.
Start with a free review
Tell us a little about your practice. We will look at where medical coding is costing you money today and walk you through what we find.
- No commitment
- Reply from an RCM specialist, typically within one business day
- No patient records needed to start
Get a free review
An RCM specialist typically replies within one business day.