Orinsols

Get Consultation

Medical Coding Services That Maximize Reimbursement & Eliminate Compliance Risk

One wrong code costs you money. A pattern of wrong codes costs you everything. OrinSols certified medical coders assign the most accurate, defensible codes for every patient encounter maximizing your reimbursement while keeping your practice fully compliant with CMS guidelines and payer requirements.

Get Your Free Coding Audit

Get Your Free Quote

99% Coding Accuracy Rate

CPC & CCS Certified Coders

ICD-10, CPT & HCPCS Expertise

All Specialties Covered

Why Medical Coding Is the Most Critical Step in Your Revenue Cycle

Medical coding sits at the intersection of clinical documentation, regulatory compliance, and financial performance. It is the process of translating every diagnosis, procedure, service, and supply from a patient encounter into the standardized alphanumeric codes that insurance payers use to determine reimbursement.

Get it right and your claims pay on the first submission at the maximum allowable rate. Get it wrong and the consequences range from delayed payments and denied claims all the way to federal fraud investigations, corporate integrity agreements, and multi-million dollar recoupment demands.

The challenge is that medical coding is not static. CPT codes are updated annually by the American Medical Association. ICD-10-CM diagnosis codes are revised every October. Payer-specific coding policies change throughout the year. Modifier rules evolve. Bundling requirements shift. New procedures emerge and new codes are created to capture them.

Keeping up with all of it while running a busy clinical practice is effectively impossible for most providers. That is why the average medical practice has a coding error rate of 7–10% and why those errors cost the US healthcare system an estimated $935 billion annually in billing inefficiencies.

OrinSols eliminates that problem. Our certified coding team stays current with every update, every guideline change, and every payer-specific policy so your claims are always coded to the highest standard of accuracy and compliance.

Contact

Medical Coding Systems We Work With

ICD-10-CM Coding (International Classification of Diseases)

ICD-10-CM diagnosis codes describe why a service was provided the medical justification for every procedure, test, and treatment billed. There are over 70,000 ICD-10-CM codes in the current code set, and selecting the most specific, accurate code for every diagnosis is both a clinical art and a technical skill. Coding to the highest specificity matters financially because payers use diagnosis codes to determine medical necessity. A claim coded with an unspecified diagnosis code where a more specific code exists is more likely to be questioned, audited, or denied. Our coders code to the maximum appropriate specificity supported by clinical documentation every time.

HCPCS Coding (Healthcare Common Procedure Coding System)

HCPCS codes cover supplies, equipment, medications, and services not captured by CPT codes including durable medical equipment, prosthetics, orthotics, drugs administered in a clinical setting, and ambulance services. HCPCS coding is particularly critical for practices that bill for infusion therapy, DME, or injectable medications. Our HCPCS coding specialists ensure every billable supply and medication is captured with the correct code, the correct quantity, and the correct supporting documentation maximizing reimbursement while maintaining full compliance with Medicare and Medicaid billing requirements.

Modifier Coding

Modifiers are two-digit codes appended to CPT codes to provide additional information about a service indicating that a procedure was performed bilaterally, that multiple procedures were performed in the same session, that a service was distinct from other services performed on the same day, or that a service was performed by a different provider than the one who ordered it. Modifier errors are among the most common and most costly in medical billing. Using the wrong modifier or failing to use one when required can result in claim denial, payment reduction, or compliance risk. Our coders understand the specific rules governing the most commonly misused modifiers including 25, 59, 51, 57, 76, 77, and the XE/XS/XP/XU family of selective modifiers.

Evaluation & Management (E&M) Coding

E&M coding covers the office visits, hospital visits, consultations, and other patient encounters that form the core of most outpatient billing. E&M codes are the most heavily audited codes in all of medical billing and the source of the most significant revenue loss through systematic undercoding. Following the 2021 AMA E&M guideline revisions and subsequent updates, E&M coding now relies on medical decision making or total time as the primary basis for level selection in most outpatient settings. Many physicians and billing teams have not fully adapted to these changes and continue undercoding leaving substantial reimbursement on the table with every single patient encounter. Our E&M coding specialists review every clinical note against current guidelines to ensure the correct level of service is assigned legally, compliantly, and at the maximum level the documentation supports.

CPT Coding (Current Procedural Terminology)

CPT codes are the foundation of medical procedure billing in the United States. Maintained by the American Medical Association and updated annually, CPT codes describe every medical, surgical, diagnostic, and therapeutic procedure that healthcare providers perform. Accurate CPT coding requires not just knowledge of the codes themselves but deep understanding of the clinical context in which they apply which procedures can be billed separately, which must be bundled, which require specific modifiers, and which payer-specific variations apply to each code under different insurance contracts. Our certified coders have years of specialty-specific CPT coding experience and maintain their credentials through ongoing continuing education that keeps them current with every annual code update and guideline revision.

Our Medical Coding Services

Inpatient Hospital Coding

Inpatient coding uses MS-DRG (Medicare Severity Diagnosis Related Group) methodology to capture diagnoses, procedures, and complications for hospital stays. Accurate inpatient coding requires certified inpatient coding credentials and deep knowledge of the sequencing rules, CC/MCC capture requirements, and documentation improvement opportunities that drive DRG assignment and reimbursement. Our inpatient coding specialists hold active CCS credentials and work with hospital coding departments, hospitalist groups, and facility billing teams to ensure every admission is coded to the full complexity that clinical documentation supports.

Outpatient & Ambulatory Coding

Outpatient coding covers emergency department visits, ambulatory surgery center procedures, hospital outpatient department services, and clinic visits billed under facility fee schedules. Outpatient coding involves APC (Ambulatory Payment Classification) grouping for facility claims alongside separate professional billing for physician services. Our outpatient coders understand the distinct rules governing facility versus professional coding and ensure both components are captured accurately and billed compliantly for every outpatient encounter.

Surgical Coding

Surgical coding is among the most complex and highest-stakes coding in all of medical billing. Operative reports must be carefully reviewed to identify the primary procedure, all secondary procedures, assistant surgeon services, anesthesia considerations, and any supplies or implants that can be separately billed. Global surgery periods, bilateral procedure rules, multiple procedure payment reductions, and add-on code requirements all affect surgical claim reimbursement and must be managed correctly to avoid both underpayment and compliance risk. Our surgical coders specialize in operative report coding across all major surgical specialties and have the experience to find billable services that general coders consistently miss.

Anesthesia Coding

Anesthesia billing uses a unique unit-based payment system that accounts for base units, time units, and qualifying circumstance units a system entirely different from standard CPT-based billing. Physical status modifiers, qualifying circumstance codes, and concurrent anesthesia rules add additional complexity that requires dedicated anesthesia coding expertise. OrinSols anesthesia coding specialists manage the complete anesthesia billing process including case timing documentation, CRNA versus anesthesiologist supervision rules, and medical direction requirements ensuring every anesthesia case is billed accurately under both Medicare and commercial payer rules.

Radiology & Diagnostic Imaging Coding

Radiology coding involves the separate capture of technical component and professional component services, correct use of TC and 26 modifiers, and accurate coding of the specific imaging study performed including laterality, contrast use, number of views, and guidance type. Our radiology coding specialists ensure every imaging study is coded with the correct CPT code, the correct components, and the correct supporting diagnosis to establish medical necessity reducing denials from the payers that scrutinize radiology billing most aggressively.

Laboratory & Pathology Coding

Laboratory and pathology coding requires specific expertise in organ or disease panel coding, molecular pathology coding, cytopathology and histopathology code selection, and the complex rules governing which laboratory services can be separately billed versus bundled with other procedures. Our laboratory coding team ensures every test and pathology specimen is captured with the correct code and appropriate diagnosis linkage maximizing reimbursement while avoiding the bundling errors and medical necessity denials that commonly affect laboratory billing.

Remote Medical Coding Services

All OrinSols medical coding services are available remotely to healthcare providers anywhere in the United States. Our coding team integrates seamlessly with your EHR, accesses your documentation through secure encrypted connections, and delivers coded encounters back to your billing system within agreed turnaround times typically 24–48 hours for standard encounters and same-day for urgent cases.

Medical Coding by Specialty

Our billing audit specialists have deep expertise across all major medical specialties:

Dentistry

Dental procedures, preventive care, and insurance claim handling with precision coding support.

OB/GYN

Maternity, prenatal, and gynecological procedure billing with global package expertise.

Neurology

EEG, EMG, and neurological testing billing with accurate CPT coding and documentation support.

Orthopedics

Surgical, fracture care, and therapy billing with correct modifier usage and global period handling.

Cardiology

Cardiac cath, echo, stress tests, and complex E&M coding with compliance accuracy.

Nephrology

Dialysis billing, ESRD management, and renal care reimbursement optimization.

Psychiatry

Mental health billing, telehealth claims, and behavioral health documentation compliance.

Primary Care

Routine visits, chronic care management, and preventive service billing solutions.

Endocrinology

Diabetes, thyroid disorders, and hormone therapy billing with accurate diagnosis linking.

Dermatology

Skin procedures, biopsies, and cosmetic vs medical billing differentiation support.

Pain Management

Injection therapies, nerve blocks, and chronic pain treatment billing services.

Infectious Disease

Complex infection treatment billing with inpatient and outpatient coding accuracy.

ASolo physician practices · Small and mid-size group practices · Large multi-location practices · Hospital outpatient departments · Ambulatory surgery centers · Behavioral health organizations · Home health agencies · Skilled nursing facilities

Medical Coding Compliance & Risk Management

OIG Work Plan Compliance

The Office of Inspector General publishes an annual Work Plan identifying the medical billing areas it has targeted for audit and investigation. OrinSols monitors the OIG Work Plan continuously and ensures our coding practices keep every client well within compliant territory on the procedures and billing patterns that attract the most government scrutiny.

RAC Audit Defense

Recovery Audit Contractors audit Medicare claims retrospectively looking for overpayments — and they have recovered billions of dollars in recoupments from healthcare providers. The most common RAC audit targets are high-level E&M codes, surgical global period violations, inpatient versus outpatient status errors, and medical necessity documentation gaps.

OrinSols coding practices are specifically designed to withstand RAC audit scrutiny. Every code we assign is supported by documentation we have reviewed, and every coding decision is defensible under current CMS guidelines.

NCCI Edit Compliance

The National Correct Coding Initiative establishes bundling rules that prevent providers from separately billing procedure code combinations that CMS considers inherently included in a single payment. NCCI edits are updated quarterly and affect thousands of CPT code combinations.

Our coding system is continuously updated with current NCCI edits, ensuring no claim leaves our system with a bundling violation that will cause a denial or a compliance finding.

Medical Necessity Documentation

Every procedure and service must be medically necessary and that necessity must be supported by the clinical documentation in the patient record. When documentation does not clearly support the medical necessity of a billed service, the claim is vulnerable to denial and the provider is vulnerable to recoupment.

Our coders work with your clinical team to identify documentation gaps and provide specific guidance on the clinical detail that payers require to support medical necessity for the services your providers perform — improving both compliance and reimbursement simultaneously.

Clinical Documentation Improvement (CDI)

The best coding in the world cannot produce accurate claims from incomplete documentation. Our CDI program works directly with your physicians and advanced practice providers to improve the specificity, completeness, and accuracy of clinical documentation — creating a foundation that supports both maximum reimbursement and maximum compliance.

We provide provider-specific documentation feedback, specialty-appropriate documentation templates, and targeted education on the documentation requirements for the highest-value services in your specialty — delivering measurable improvement in both coding accuracy and claim reimbursement.

Our Medical Coding Quality Assurance Process

First-Level Coding — Every encounter is coded by a credentialed specialist with expertise in your specific specialty. No generalist coders. No offshore coding without oversight. Every coder assigned to your account has demonstrated competency in your specialty's specific coding requirements.

Second-Level Review — A senior coder reviews a statistically significant sample of coded encounters every week — checking for accuracy, consistency, and compliance with current guidelines. Any errors identified are corrected before claim submission and used as coaching opportunities to prevent recurrence.

Denial-Driven Audit — Every coding-related denial triggers an immediate review of the affected claim and an audit of similar claims to identify whether the denial reflects a systemic coding error or a one-time issue. Systemic errors are corrected at the workflow level — not just claim by claim.

Annual Coding Update Training — Every member of our coding team completes mandatory training on annual CPT and ICD-10-CM code updates before the effective date of each update. Your claims are never submitted with outdated codes because our team fell behind on training.

Payer Policy Monitoring — Our compliance team monitors payer-specific coding policy updates and local coverage determinations from all major payers throughout the year — updating our coding protocols whenever payer policies change to keep your claims aligned with current requirements.

How Our Billing Audit Helps You Prepare for Government Audits

Key Benefits of Outsourcing Medical Coding to OrinSols

Immediate access to certified coding expertise without the cost of hiring, training, and retaining in-house coders. Specialty-specific coding accuracy that generalist billing staff cannot match. Elimination of coding-related denials through clean claim submission the first time. Reduced compliance risk through coding practices that withstand payer and government audit scrutiny. Faster reimbursement through first-pass claim acceptance rates that consistently exceed 97%. Scalability our coding team scales immediately with your volume without hiring delays or training ramp-up periods. Continuous improvement through quality audits, denial analysis, and coder education that get better over time. Transparency through monthly coding accuracy reports and direct access to your coding team.

Medical Coding Credentials Our Team Holds

Certified Professional Coder (CPC) American Academy of Professional Coders. Certified Coding Specialist (CCS) American Health Information Management Association. Certified Coding Specialist Physician-based (CCS-P). Certified Inpatient Coder (CIC). Certified Outpatient Coder (COC). Specialty-specific certifications including Certified Cardiology Coder (CCC), Certified Orthopedic Coder, and others. All coders complete annual continuing education requirements to maintain active certification status.

RCM for Small & Mid-Size Group Practices

Frequently Asked Questions About Medical Coding Services

How do I know if my practice has a coding problem?

The most common indicators of coding problems are a high denial rate for medical necessity reasons, a pattern of downcoded claims from payer audits, consistently low E&M code distribution compared to specialty benchmarks, a high rate of documentation requests from payers, and revenue that has not kept pace with patient volume growth. A free coding audit from OrinSols will identify any coding problems your practice has within 48 hours.

No. OrinSols coding turnaround is typically 24–48 hours for standard outpatient encounters and same-day for urgent cases. Most practices find that our turnaround is faster than their previous in-house or outsourced coding process because we use dedicated specialty teams rather than generalist coders handling mixed work queues.

When a procedure does not have a specific CPT code, our coders select the most appropriate unlisted procedure code and prepare detailed supporting documentation to accompany the claim including a cover letter explaining the procedure and justifying the fee relative to the most analogous listed procedure. We have extensive experience obtaining payment for unlisted procedures from payers that resist them.

Yes and this is one of the most common and most valuable things we do for new clients. E&M undercoding is extremely widespread, and correcting it does not create compliance risk as long as the higher-level codes are supported by the clinical documentation. Our E&M coding specialists review your documentation against current AMA guidelines and code to the level the documentation actually supports — not the level your physicians habitually select out of excessive caution.

Yes. If you prefer to keep coding in-house but want to improve your team’s accuracy and compliance, OrinSols offers medical coding education and training programs for existing billing and coding staff. We provide specialty-specific training, annual code update education, and targeted coaching based on your practice’s specific denial patterns and audit findings.

Telehealth coding involves specific place of service codes, originating site modifiers, and payer-specific telehealth coverage policies that vary significantly across payers and change frequently. Our coders stay current on all telehealth billing rules and apply them correctly for every payer ensuring your telehealth claims are coded compliantly and paid on the first submission.

Inpatient hospital services are coded using ICD-10-PCS procedure codes for inpatient procedures and ICD-10-CM diagnosis codes for diagnoses — a completely different system from outpatient CPT coding. DRG assignment for Medicare and Medicare Advantage inpatient claims is driven by the principal diagnosis, secondary diagnoses, procedures performed, and presence of complications or comorbidities. Our CCS-credentialed inpatient coders have specific expertise in this system.

Accuracy over time requires systematic quality assurance not just good intentions. Our quality assurance process includes weekly second-level reviews of random claim samples, monthly accuracy reporting by coder and by code category, denial-driven audits that investigate every coding-related rejection, and mandatory annual training on code updates and guideline changes. Our coding accuracy rate across all clients consistently exceeds 99%.

Any denial traced to a coding error is corrected and resubmitted immediately at no additional charge. We also conduct a root cause analysis to determine whether the error reflects a systemic issue affecting other claims and if it does, we identify and correct all affected claims proactively rather than waiting for additional denials to surface.

Book An Appointment

Get Your Free Medical Coding Audit Today

A coding error you do not know about is money you will never recover. Our free medical coding audit reviews a sample of your recent claims against your clinical documentation and delivers a clear assessment of your coding accuracy, compliance risk, and revenue recovery opportunity within 48 hours, at no charge, with no obligation. Most practices that complete a coding audit with OrinSols discover at least one significant and immediately correctable coding pattern that is costing them thousands of dollars per month. The question is not whether the problem exists. The question is how much longer you can afford not to find it.