Compliant coding and billing
A billed code holds up when the note and the current guideline support it.
ReadCoding & Billing
Coding guidelines, modifiers, rebilling, and practical CPT, HCPCS, and ICD-10 application.
Coding is a language with rules. When the note, the code, and the payor’s edit do not agree, the claim fails or, worse, it pays and becomes an audit exhibit. The firm’s coding work sits at that intersection.
Reviewed by Joseph Rivet · September 29, 2026
The Challenge
The note has to carry the code
A code that is technically available is still wrong if the documentation does not support it. Reviewers do not give credit for what the clinician ‘meant.’
Payor requirements
Medicare and commercial rules that decide whether the code on the claim is payable.
ReadModifier compliance
A 25, 59, or 76 used only when the record earns it, including when an NCCI edit applies.
ReadRebilling and corrected claims
A correction when the original claim was factually wrong, sent so the record stays clear.
Learn morePlace of service
Office, outpatient, and facility claims billed as the setting where the service was furnished.
ExploreDrug coding
Drug and infusion codes billed the way the coverage manual describes the service.
ReadDurable medical equipment coding
An order, a coverage criterion in the record, and proof of delivery that agree with each other.
Learn moreEmergency medical services coding
Transport codes and mileage supported by the run sheet and the medical-necessity rule.
Read
Who We Help
Who this work is for
Counsel here is grounded in CPT, HCPCS, ICD-10-CM, and ICD-10-PCS as they are used on a claim, not only as they appear in a manual. Joseph Rivet came to the law from coding, billing, and revenue-cycle operations.
- Groups rewriting an E/M or modifier policy
- Practices rebilling after a system or vendor change
- Hospitals sorting place-of-service or drug-coding questions
- EMS, DME, and specialty lines with their own code sets
Our Process
First steps you can take today
These steps organize the file. They are not a substitute for counsel.
- 1
Pick one code or modifier that generates the most rework this month.
- 2
Pull ten charts and score whether the note supports the code billed.
- 3
Write the rule in one sentence a coder can use without a meeting.
- 4
If missed appointments are being billed, run the calculator before the next statement cycle.
The note has to carry the code
A code that is technically available is still wrong if the documentation does not support it. Reviewers do not give credit for what the clinician ‘meant.’
Modifier problems are the same story in miniature: a 25, 59, or 76 that is habitual rather than earned. The fix is a rule the coders can apply on Tuesday afternoon, not a memo that lives in a binder.
Corrected claims without making it worse
Rebills create a second record. If the first claim is already under review, a quiet correction can look like concealment. Sequence matters.
When a system configuration caused the error, fix the configuration and document the date it changed. That date often becomes the edge of any repayment discussion.
Common questions
- Is ‘everyone bills it this way’ a defense?
- No. Local habit is not a coding guideline. The question is whether the current CPT, HCPCS, or ICD-10 instruction, plus the payor’s published policy, supports the claim.
- When should a claim be corrected instead of appealed?
- Correct when the original claim was factually wrong. Appeal when the original claim was right and the payor applied the rule incorrectly. Doing both at once confuses the record.
Working tool
60-second estimateEstimate the cost of unbilled no-shows
If the practice is considering a no-show or late-cancellation charge, start with the numbers. Policy and payor rules come next. The calculator does not tell you to bill.
When you want help
Bring the letter, the remittance, or the agreement.
If the first steps on this page raised a question, the firm can sit with the file.
This page is educational. It is not legal advice and does not create an attorney-client relationship. Facts, contracts, and appeal windows control the next step.