The claim can only say what the operative report says.

Precision codes surgical and procedural claims from the report itself, tells the surgeon when the documentation limits the code, and prepares the file when a payer disputes the payment. The work is led by a Certified Outpatient Coder who is also a certified professional coder and medical auditor.

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For surgeons, surgical practices, ambulatory surgery centers and outpatient hospital departments.

Modifiers in daily use

And the NCCI procedure-to-procedure edits behind them.

Coded from the operative report

Surgical coding depends on the surgical package, the modifier rules, the edits between procedures, and the way each specialty documents. The coder reads the whole report, not the charge slip.

Final code assignment remains with the practice or facility and the treating surgeon. Recommendations reflect the documentation provided and the payer policy in effect at review.

What the coding covers

Operative and procedural reports reviewed; CPT, ICD-10-CM and HCPCS codes assigned
Modifiers selected to match payer policy and NCCI logic
Assistant-at-surgery and co-surgeon coding
Global surgical package management
Feedback to the surgeon when a documentation gap changes the code

Surgical and procedural specialties coded

Orthopedic, hand, spinal, general, trauma, emergency medicine, plastic and reconstructive, bariatric, vascular, cardiothoracic, thoracic, neurosurgical, ENT, ophthalmic, urologic, gynecologic, surgical oncology and colorectal.

Beyond surgery, we bill for all medical providers, and for ancillary providers: rehabilitation (physical therapy and occupational therapy), acupuncture, nurse practitioners and chiropractors.

How we work with practices

When you stay out of network

Staying out of network takes its own billing setup. Each carrier has to know where to send payment, the fee schedule has to be defensible, and the estimates and disclosures have to meet the federal No Surprises Act and state surprise-billing law.

Out-of-network payment varies materially by payer, plan, geography and benefit design. No reimbursement rate or collection percentage is represented or guaranteed.

What the setup includes

Registration with each non-contracted carrier, so payment routes to the practice or facility
Fee schedule construction and claim submission protocols
Good Faith Estimates for self-pay and out-of-network patients
Patient-responsibility consent and disclosure documents
Review against state surprise-billing law, including New Jersey's
Weekly tracking of payer checks mailed to the patient

When payment is disputed

Some claims do not resolve through standard appeals. The dispute is no longer about the code. It is about how the policy and the regulation are read.

The federal No Surprises Act process and the state process are not the same process. Federal Independent Dispute Resolution and New Jersey's out-of-network arbitration each have their own rules on which plans and services qualify, their own filings and their own decision-maker. The first question on a disputed out-of-network payment is which one applies.

Federal: No Surprises Act IDR

Files prepared for federal Independent Dispute Resolution under 45 C.F.R. § 149.510: eligibility, the offer and the written argument.

State: out-of-network arbitration

Files prepared for the state process, including arbitration under New Jersey's out-of-network law: eligibility, the final offer and the written argument.

Negotiation

Direct negotiation with the payer on high-dollar and out-of-network claims: single-case agreements, case rates and settlement of disputed adjudications.

Fee schedule review

Your fee schedule reviewed code by code against FAIR Health regional benchmark data, with recommended changes and the percentile reasoning for each.

Federal IDR outcomes are determined by the certified IDR entity, and state arbitration outcomes by the arbitrator. Dispute support is provided in a non-attorney capacity, in coordination with your counsel.

When an auditor asks for records

RAC, UPIC, MAC and commercial audits and refund demands.

Where fraud or significant overpayment is alleged, we work alongside your counsel and stay in the coding and regulatory lane.

What the response includes

The request triaged against its deadline
Records assembled and the response packet prepared
Documentation tested against the cited code and guideline
Position statements drafted with regulatory and guideline citations
Appeals prepared through Medicare's five levels or the commercial equivalent

If you are changing billing company, system or tax ID

Receivables left in the old system are worked as their own time-limited project: triaged for recoverability by age, payer and balance, followed up where recoverable, and closed out with documentation where not. Current billing runs alongside.

For a tax-ID change, payers, clearinghouses and EFT recipients are notified on a planned timeline, and the first 90 days after the change are monitored.