Code What You Did. Get Paid for All of It — and Nothing You Can’t Defend.
Coding is the most controllable cause of denials and the most common reason payers take money back. MedVersify codes your encounters from the documentation, levels E/M visits by medical decision making or time, applies modifiers only where the note supports them, and audits the results so undercoding and overcoding both get caught.
- E/M leveling by MDM or total time
- CPT, ICD-10-CM, and HCPCS Level II
- Modifier 25, 59, and X{EPSU} review
- NCCI and MUE edits before submission
- HCC risk-adjustment capture
- Provider-level documentation feedback
Every Code Change and Every Audit Lands on the Claim
418
CPT Code Changes for 2026
The 2026 CPT code set brought 288 new codes, 84 deletions, and 46 revisions — all effective January 1.
American Medical Association, CPT 2026
8.44%
Part B Improper Payment Rate
Medicare’s auditors found 8.44% of Part B provider payments were improper in FY 2025 — most often because the documentation didn’t support what was billed.
CMS CERT program, FY 2025
$28.8B
Medicare FFS Improper Payments
Across all of Medicare fee-for-service, the FY 2025 improper payment rate was 6.55% — about $28.83 billion, much of it recoverable from providers.
CMS FY 2025 improper payments fact sheet
100%
CMS-HCC V28 for 2026
The V28 risk-adjustment model is fully phased in for 2026 Medicare Advantage payments, removing or remapping many diagnosis codes that used to carry risk weight.
CMS Advance Notice / Rate Announcement
Coding Done From the Note, Checked Before the Claim Goes Out
Medical coding is included in our full medical billing service. Practices that bill in-house can use us for coding only, or for a one-time or quarterly coding audit.
E/M leveling by MDM or time
Office and outpatient visits (99202–99215) are leveled by medical decision making or by total time on the date of the encounter — whichever the note supports better. Note length and exam bullet counts no longer decide the level.
Procedure coding (CPT & HCPCS)
Procedures, injections, drugs, supplies, and in-office tests coded with the right units, laterality, and HCPCS Level II codes, using the current year’s code set.
Diagnosis coding to full specificity
ICD-10-CM codes assigned to the highest specificity the documentation supports, with the annual October update applied by date of service. See our FY2027 ICD-10-CM update guide.
Modifier review
Modifier 25 is checked for a significant, separately identifiable E/M service. 59 and the X{EPSU} modifiers are used only when the note shows a distinct service — the most audited modifiers on any claim.
NCCI and MUE edits
Each claim is checked against the quarterly National Correct Coding Initiative procedure-to-procedure edits and medically unlikely edits before submission, not after a CO-97 denial.
HCC risk-adjustment coding
For Medicare Advantage and other risk-based contracts, chronic conditions are captured and documented every calendar year, mapped to the current CMS-HCC model.
Medicare add-on codes
G2211 for longitudinal care, prolonged services (G2212 for Medicare, 99417 for most others), and care-management codes like CCM and TCM — services many practices perform but never bill.
Coding audits
A random sample of each provider’s encounters is re-coded independently. You get an accuracy rate, the dollar impact of under- and overcoding, and the specific documentation changes that fix it.
AI scribe and auto-coding review
If your notes come from an ambient AI scribe or codes are suggested by software, we audit the output. Longer notes don’t automatically support higher levels — see our ambient scribe coding risk guide.
Office Visit E/M Codes at a Glance
Since 2021, office and outpatient E/M visits are leveled by medical decision making (MDM) or by total time the billing practitioner spent on the date of the encounter. The same framework was extended to hospital, emergency, nursing facility, and home visits in 2023.
Office/outpatient E/M levels by MDM and time
| Code | Patient | Medical decision making | Total time (must be met or exceeded) |
|---|---|---|---|
| 99202 | New | Straightforward | 15 minutes |
| 99203 | New | Low | 30 minutes |
| 99204 | New | Moderate | 45 minutes |
| 99205 | New | High | 60 minutes |
| 99212 | Established | Straightforward | 10 minutes |
| 99213 | Established | Low | 20 minutes |
| 99214 | Established | Moderate | 30 minutes |
| 99215 | Established | High | 40 minutes |
MDM is met when two of its three elements are met: number and complexity of problems, amount and complexity of data reviewed, and risk of patient management. Source: AMA CPT E/M guidelines. 99211 has no MDM or time threshold.
The modifiers payers audit most
| Modifier | What it tells the payer | When it’s supported |
|---|---|---|
| 25 | A significant, separately identifiable E/M service on the same day as a procedure | The note documents work beyond the usual pre- and post-procedure evaluation |
| 59 | A distinct procedural service | Different session, site, incision, or injury — and no more specific X modifier applies |
| XE | Separate encounter | The service happened in a different encounter on the same date |
| XS | Separate structure or organ | Performed on a different organ or anatomic structure |
| XP | Separate practitioner | Performed by a different practitioner |
| XU | Unusual non-overlapping service | Doesn’t overlap the usual components of the main service |
| 95 | Synchronous telemedicine | Real-time audio-video visit, where the payer requires the modifier |
Payers increasingly target modifier 25 and E/M levels 4–5 with automated review. See our guide to [payer downcoding of E/M claims](/blog/payer-ai-downcoding-em-claims-2026).
The Coding Problems We Find Most Often in Practice Audits
Undercoding out of fear
Many providers default to 99213 to stay “safe.” When the documented MDM supports 99214, that habit gives away revenue on every visit — and it doesn’t reduce audit risk.
Time-based visits without a time statement
Leveling by time only works when the note states the total time and what it included. A visit that took 45 minutes but doesn’t say so can only be coded by MDM.
Modifier 25 on every procedure day
Adding 25 automatically whenever a procedure is billed is one of the most common audit findings. The E/M has to stand on its own in the note.
Unspecified diagnosis codes
Codes like “unspecified” laterality or type trigger medical-necessity denials and lose risk-adjustment value when the note actually contains the detail.
Chronic conditions not documented every year
Risk-adjusted diagnoses reset every January. A condition managed all year but not documented with assessment and plan doesn’t count toward the risk score.
Billable add-ons left off
G2211, prolonged services, chronic care management, and transitional care management are routinely performed and never billed.
How MedVersify Codes and Audits
Baseline audit
We re-code a sample of each provider’s recent encounters to measure accuracy and the revenue impact of current habits.
Specialty coding rules
We build your practice’s payer-specific edit list: modifier policies, frequency limits, and LCD coverage rules for your top codes.
Code from documentation
Encounters are coded from the signed note. Anything unclear goes back to the provider as a query, not a guess.
Pre-bill edit check
Every claim passes NCCI, MUE, and payer-specific edits before submission.
Provider feedback
Each provider gets short, specific feedback — the two or three documentation changes that would make the biggest difference.
Quarterly re-audit
Accuracy is re-measured every quarter, and every January and October when the code sets change.
Frequently Asked Questions
What do medical coding services include?
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How are E/M office visits leveled in 2026?
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How often should a practice do a coding audit?
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What is G2211 and can we bill it?
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What is HCC coding?
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Can you code notes created by an AI scribe?
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Do you offer a one-time coding audit without ongoing coding?
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Free Coding Review
Find Out What Your Coding Is Leaving on the Table.
A short audit of your recent encounters shows your accuracy rate, the revenue impact, and what to change — whether or not you outsource coding to us.
Prefer to call? (507) 312-9282Sources
- AMA — CPT evaluation and management (E/M) services guidelines
- CMS — National Correct Coding Initiative (NCCI) edits
- CMS — Comprehensive Error Rate Testing (CERT)
- CMS — Fiscal year 2025 improper payments fact sheet
- CMS — ICD-10 code sets
- CMS — Evaluation & management visits (MLN)
Payer rules change often. Figures and deadlines on this page reflect the sources above as of the date they were published — confirm against your payer contract and current CMS guidance before relying on them for a specific claim.