Outsourced Medical Coding
Medical Coding Services by AAPC and AHIMA Certified Coders
Accurate coding is the difference between a claim that pays and one that comes back. ClainetRCM's certified coders assign and review ICD-10-CM, CPT and HCPCS codes on every chart before it reaches a claim, so errors are caught at the documentation, not at the clearinghouse.
- AAPC and AHIMA certified coders
- HIPAA compliant, BAA signed
- 50+ specialties
- Practices in all 50 states
Last updated .
What Are Medical Coding Services?
Medical coding services translate a provider's clinical documentation into the standardized codes payers use to process claims: ICD-10-CM for diagnoses, CPT for procedures and visits, and HCPCS Level II for supplies, drugs and equipment.
A medical coding company takes that work off your providers and staff. Coders read the note, select codes the documentation supports, apply the right modifiers, and check the claim against payer edits before it is billed.
Coding errors cut both ways. Undercoding leaves earned revenue uncollected. Overcoding, or coding that the note does not support, creates denials, refund demands and audit risk. Our job is to code exactly what was documented, and to tell you when the documentation is the problem.
The Code Sets We Work In, and What We Check
| Code set | What it describes | What our coders verify |
|---|---|---|
| ICD-10-CM | Diagnoses and reasons for the visit | Highest specificity, laterality, sequencing, and that the diagnosis supports medical necessity for each billed service. Updated every October 1, with a smaller update on April 1. |
| CPT | Procedures, visits and services | Correct code for the work documented, bundling under NCCI edits, units, and global period rules. Updated every January 1. |
| HCPCS Level II | Drugs, supplies, DME and some services | Billing units, drug wastage modifiers JW and JZ, and payer-specific coverage rules. |
| E/M codes | Office, hospital and consult visits | Level supported by medical decision making or total time under current guidelines, as in our guide to CPT code 99213. |
| Modifiers | Circumstances that change how a code is paid | Correct use of 25, 59 and the X modifiers, 26 and TC, 50, 51, 76 and others, with documentation that supports each one. |
| Coverage policies | Medicare NCDs and LCDs, commercial medical policies | Diagnosis-to-procedure linkage, frequency limits and MUE values before the claim is built. |
Medical Coding Services We Provide
Professional Fee Coding
Day-to-day coding of office visits, procedures and hospital services for physicians, nurse practitioners, physician assistants and therapists.
E/M Coding and Leveling
Evaluation and management levels selected from the documentation using medical decision making or time, with feedback when notes do not support the level billed.
Surgical and Procedural Coding
Operative report coding with correct modifiers, multiple-procedure rules, assistant and co-surgeon billing and global period tracking.
Coding Audits
Pre-bill and retrospective medical coding audit services that measure accuracy, find under- and overcoding, and identify documentation gaps.
Coding Denial Review
Coding-related denials such as CO-4, CO-11 and CO-97 are traced to the cause, corrected and fed back so they stop repeating.
Provider Documentation Feedback
Clear, specific queries and periodic feedback that help providers document what payers need without adding time to the visit.
Our Medical Coding Process
A repeatable process, with a second review before anything is billed.
Secure chart access
After a BAA is signed, coders access encounter notes, operative reports and results directly in your EHR.
Code assignment
A certified coder assigns ICD-10-CM, CPT and HCPCS codes and modifiers based only on what is documented.
Edit validation
Codes are checked against NCCI procedure-to-procedure edits, MUE limits and the relevant NCD, LCD or commercial policy.
Quality review
Charts are reviewed before release, so mismatches between the note and the codes are caught before the payer sees them.
Provider queries
If documentation is unclear or incomplete, we send a specific query rather than guessing.
Release to billing
Coded charges move to billing so the claim can be filed within 24 to 48 hours.
Why Outsource Medical Coding to ClainetRCM
Medical coding outsourcing works when the coders are certified, specialty-aware and accountable for accuracy.
Certified coders only
Your charts are coded by AAPC and AHIMA credentialed coders, not by generalist data-entry staff.
Specialty-aware coding
Coders are matched to your specialty, from cardiology device checks to dermatology lesion sizing and oncology drug units.
Current with code updates
We track the annual ICD-10-CM and CPT updates, quarterly HCPCS and NCCI changes, and payer policy revisions.
Documented, auditable work
Coding decisions and provider queries are recorded, which supports you if a payer asks for records.
Coding only, or coding plus billing
Use us as your medical coding company on its own, or combine coding with medical billing for a single team.
HIPAA compliant
A BAA is signed before any record changes hands, with encrypted, access-controlled systems.
Medical Coding for Every Specialty, in Every State
Coding rules are national, but payment rules are local. Medicare Administrative Contractors publish their own Local Coverage Determinations, state Medicaid programs set their own code and modifier requirements, and commercial payers apply their own edits.
ClainetRCM provides medical coding services to practices across the United States and applies the coverage policies of the payers you actually bill.
Find your state
Coding by specialty
Medical Coding Services: Frequently Asked Questions
What is the difference between medical coding and medical billing?
Medical coding translates clinical documentation into ICD-10, CPT and HCPCS codes. Medical billing uses those codes to build, submit and follow up on claims. Coding comes first, and billing depends on it being right.
Is outsourcing medical coding cheaper than hiring in-house coders?
It often is for small and mid-sized practices, because you avoid salary, benefits, training, certification upkeep and the cost of backlogs when a coder leaves. The right answer depends on your chart volume and specialty mix, which is why we review a sample of your charts before quoting.
How do you protect coding accuracy?
Every chart is coded by a certified coder, validated against NCCI edits and coverage policies, and reviewed before release. Unclear documentation triggers a provider query instead of an assumption.
How long does it take to start with a medical coding company?
Onboarding takes 7 to 14 business days. We sign a BAA, set up EHR access, review your current coding patterns and agree on turnaround times before go-live.
Do you support all specialties?
We code for more than 50 specialties, including cardiology, orthopedics, dermatology, gastroenterology, oncology, surgery, radiology, mental health and primary care.
How do you handle annual code updates?
The main ICD-10-CM update takes effect on October 1, with a smaller one on April 1. CPT changes arrive on January 1, and HCPCS and NCCI edits are updated quarterly. Our coders apply updates on their effective dates and tell you about changes that affect your most-billed codes.
Can you audit our in-house coders' work?
Yes. We offer medical coding audit services on a sample of your charts, with a written report of accuracy, undercoding, overcoding and documentation gaps.
Is outsourced medical coding HIPAA compliant?
Yes, when the coding company signs a Business Associate Agreement and protects PHI. We sign a BAA with every client and work through encrypted, access-controlled systems.
Find Out What Your Coding Is Costing You
Send us a sample of recent charts and our AAPC and AHIMA certified coders will show you where documentation or code selection is costing you reimbursement. We sign a BAA before any record changes hands.