Medical Coding Services For Your Practice.
Coding is where the clinical record becomes a claim. We code from the completed record, check every claim against payer edits, send compliant questions when the record is unclear, and keep up with code changes every quarter.
- Included with Full RCM
- Optional with Medical Billing
- Keep your existing EHR
Your CliniciansComplete the record
How Coding Fits Your Service.
Pick a service level to see who handles each part of coding.
Your Practice 
OneBill RCM TeamWith Full RCM, coding is included alongside registration support, eligibility, prior authorization, credentialing and billing.
Compare Medical Billing And Full RCMThe Edits Every Claim Must Pass.
A correctly coded service can still be denied if it trips an edit. We check claims against these before they go out.
NCCI Procedure-To-Procedure Edits
Some services are bundled into others when done together. A modifier such as 59 or XS, XE, XP or XU overrides an edit only when the record shows a truly separate service.
Medically Unlikely Edits
Maximum units per service per day. Units above the limit need documentation, and some limits cannot be exceeded at all.
Coverage Policies
National and local coverage determinations list which diagnoses support a service. The diagnosis on the claim has to match the record and the policy.
Plan-Specific Policies
Commercial plans add their own bundling, frequency and modifier rules on top of the national edits.
Visit Levels By Decision-Making Or By Time.
Office and most other visit codes are chosen by medical decision-making or by total time on the date of service. Decision-making has three elements; a level needs two of the three.
Problems Addressed
Number and complexity of the problems managed at the visit.
Data Reviewed
Tests ordered or reviewed, outside records, independent historians and interpretation.
Risk Of Management
Risk of complications from the treatment decisions, such as prescription drug management or surgery decisions.
When The Record Is Unclear, We Ask. Properly.
A coding question should never lead the clinician to a more valuable answer. Ours present the clinical facts from the record and offer every reasonable option, including "unable to determine".
We do not add services or diagnoses the record does not support.
The note documents a hemoglobin A1c of 9.2% and "diabetes" without type or complications. Based on your clinical judgment, please clarify the diagnosis:
- Type 2 diabetes, with hyperglycemia
- Type 2 diabetes, without complications
- Type 1 diabetes
- Other
- Unable to determine
Fictional example. No real patient data.
Details That Change The Diagnosis Code.
Laterality
Right, left or bilateral for limbs, eyes, ears and more.
Episode Of Care
Injury codes use a seventh character for initial care, subsequent care or sequela.
Type And Complications
Diabetes, for example, is coded by type and by each documented complication.
Combination Codes
One code can capture a condition and its manifestation, replacing two.
Questions Before You Book.
Is Coding Included In Medical Billing?
It is optional with Medical Billing and included with Full RCM.
Can We Keep Our In-House Coder?
Yes. We bill from the codes your team provides, check them against payer edits and send back any denial that points to a coding issue.
How Do You Keep Up With Code Changes?
ICD-10-CM updates every October 1 (and sometimes April 1), CPT mainly every January with some codes released during the year, and HCPCS every quarter. We apply each update and flag changes that affect your common services.
Can You Review Our Current Coding First?
Yes. A billing audit includes a review of coding, modifiers and charge entry.
Do You Code For Medicare Advantage Risk Adjustment?
Yes. We code the diagnoses your clinicians document and assess, with the specificity the record supports, and send compliant questions when it is unclear.
Keep Coding Connected To Your Claims.
Tell us how coding works in your practice today and where claims get held up. We will walk through scope, fees and next steps, with no commitment.
- Included with Full RCM, optional with Medical Billing
- Your clinicians keep the documentation
- Keep your existing EHR