Medical Coding & Coding Audits

Medical coding turns what happened during a visit into standard codes that payers understand. Diagnosis codes show why care was needed. Procedure and service codes show what was done. If the codes do not match the documentation, claims can be denied, underpaid or flagged in an audit.

Outsourced medical coding services give your practice trained coders and, when needed, independent reviews of past work. Westmont Revenue Partners connects practices and facilities with vetted medical billing experts who code from your documentation, spot gaps, and run coding audits. A good medical coding company also gives feedback so providers can improve their notes over time.

Who this is for

Practices without a certified in-house coder
Specialties with complex procedures, modifiers or frequent code changes
Practices with high denial rates tied to coding or medical necessity
Groups preparing for payer reviews or wanting a risk check
Practices that have added new services or providers
Providers who suspect they are under-coding or over-coding visits

What's included

Assigning diagnosis codes from provider documentation
Assigning procedure and service codes
Selecting and checking modifiers
Reviewing evaluation and management level selection
Querying providers when documentation is unclear
Checking claims against edits, such as code pair and unit limits
Retrospective coding audits on a sample of charts
Pre-bill audits before claims go out
Written findings with error types and education points
Provider and staff coding education
Updates for annual code set changes
Support with coding-related denials and appeals

How it works

You choose the scope: ongoing coding, a one-time audit, or both.
Westmont matches you with coders or auditors experienced in your specialty.
Charts or encounter documentation are shared securely through your system or an agreed method.
Coders assign codes and raise questions to providers. Auditors review a sample against documentation and payer policy.
Results are summarized, with errors grouped by type and provider.
You review findings, apply fixes and decide whether to follow up with a repeat audit.

Common challenges

Documentation that does not support the code. A visit may be under-documented even when the care was good. Coders raise queries and educate providers on what to add.
Choosing the right visit level. Office visit levels can be based on medical decision making or total time. Experienced coders know which method the note supports and apply the current guidelines.
Modifier misuse. Modifiers explain special circumstances, and the wrong one can trigger a denial or a review. Coders check payer rules before applying them.
Bundling edits. Some codes cannot be reported together or are limited by units per day. Coders review edit logic, such as NCCI, before billing and avoid unsupported combinations.
Annual code updates. Code sets change each year, and diagnosis codes update every October. Coders retrain and update templates and charge masters to match.
Medical necessity links. A procedure needs a diagnosis that supports it under payer policy. Coders review coverage rules and flag mismatches early.
Inconsistency between providers. Different clinicians code similar visits differently. Audits reveal patterns, and education brings them in line.

Metrics worth tracking

Coding accuracy rate: the share of audited charts coded correctly
Denials by coding reason: shows where claims fail on codes or modifiers
Query rate and response time: shows documentation clarity and provider engagement
E/M level distribution: shows patterns that may indicate over- or under-coding
Charge lag: shows how long it takes from visit to coded charge
Audit findings by provider: shows where education will help most
Rework rate: shows how often claims are corrected after coding

Codes and standards

Code or standard	Type	What it covers
ICD-10-CM	Code set	Diagnosis codes, maintained by the CDC and updated each October
ICD-10-PCS	Code set	Inpatient hospital procedure codes, used mainly for facility claims
CPT (HCPCS Level I)	Code set	Procedures and services, maintained by the AMA and updated annually
HCPCS Level II	Code set	Supplies, equipment, ambulance and other items outside CPT, maintained by CMS
Office and outpatient E/M codes (99202-99205 new patient, 99211-99215 established patient)	CPT codes	Office visit levels, selected by medical decision making or total time
Modifiers	Code additions	Two-character additions that explain special circumstances for a service
NCCI procedure-to-procedure edits	CMS edits	Code pairs that generally should not be billed together
NCCI medically unlikely edits	CMS edits	Limits on the units of a service that are generally reported for one patient on one date of service

Note

Codes and standards are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Specialties that use this service

How Westmont can help

We match you with vetted coders and auditors who know your specialty
We look for providers who work inside your EHR or practice management system
We help you decide between ongoing coding support and periodic audits
We connect coding with billing and denial work so findings lead to fixes

Frequently asked questions

What does a medical coding company do?

A medical coding company reads provider documentation and assigns the diagnosis and procedure codes used on claims. It also checks modifiers, applies payer and code set rules, and queries providers when notes are unclear. Many also perform audits and train staff so coding quality improves over time.

What is a coding audit?

A coding audit compares billed codes with the documentation in the chart. A reviewer checks whether the codes are supported, whether anything was missed and whether payer rules were followed. Audits can be done before claims go out or afterward, and results guide education and corrections.

Do I need certified coders?

Many practices look for coders with recognized credentials and experience in their specialty. Credentials do not replace specialty knowledge, so ask about both. Westmont matches you with vetted experts, and you can ask the provider about the training and experience of the people who will work on your charts.

How often should we audit our coding?

That depends on your risk, volume and history. Some practices audit a sample regularly, and others audit after a denial spike, a new provider start or a payer inquiry. Your matched auditor can suggest a schedule that fits your situation.

Can coding fix my denials?

It can help when denials come from wrong codes, missing modifiers, or unsupported medical necessity. Not all denials are coding issues, though. Some stem from eligibility, authorization or timing. A good provider sorts denials by cause and fixes the right problem.

Related services

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