Review coding with the Coding Review drawer

how-to ⏱ 8 min read Billing Updated 2026-08-31

Coding Review is where you verify that the codes on a claim match the note that supports them, without leaving the Work Queue. It opens as a right-side drawer with the clinical summary on the left, the billing codes on the right, and every override attributed and logged.

Before you start

You have the biller role, or admin.
A claim exists on the encounter — the drawer is reachable only when the row has a claim.
You can read the progress note that the drawer surfaces alongside the codes.

Open it

From /facility/{facility_uuid}/billing/work-queue, click Review on any row that has a claim. The drawer slides in from the right. Use ← / → at the top to move to the previous or next claim in the current queue without closing the drawer.

The header shows the patient, DOS, payer, rendering clinician, and a timely-filing badge (Nd to file or Nd PAST DEADLINE). If the visit is not signed, a red banner across the top says so — the claim cannot be submitted until the provider signs.

What the two panels show

The drawer is a two-column layout.

Left — Clinical Summary. Read-only cards pulled from the progress note that supports this claim:

Wound Assessment (section 7)
Procedures & Supplies (section 11)
Objective Assessment (section 4)
Provider Attestation (section 17)
View Full Note opens the PDF in a new tab.

Coding Review now resolves the correct note for a claim across three ID namespaces, not just one — so notes that used to render as "no note" now appear. Before the fix, ~87% of claims had no note surface in the drawer even when a signed note existed; after the fix, coverage on the reachable set jumped from 60 to 174 of 461 clinical notes on production.

Right — Billing Codes. Editable:

Place of Service (two-digit code, e.g. 12)
Billing Codes (procedures with modifiers, units, and diagnoses; each procedure line carries its own diagnosis pointers)
Expected Total rolls up automatically from the line charges
Claim Status inline dropdown mirrors the Work Queue value

Validation warnings and errors

Above the two panels, two banners surface issues on the current claim:

Banner	Meaning	What it does
Red — validation errors	The claim payload is structurally broken (missing subscriber, missing service line, etc.).	Submission is blocked until you fix them.
Yellow — warnings	Codes look inconsistent with the visit (diagnosis not linked to a line, modifier missing, out-of-range units).	Advisory only; save and submit are still available.

Fix red items in the drawer or in Edit in Full Form. Yellow items are worth resolving but do not block save.

Steps — work one claim

Read the Wound Assessment and Procedures & Supplies on the left. Confirm the encounter matches the codes on the right.
Set Place of Service if the wrong value is on the claim (12 for home, 11 for office, etc.).
Adjust the code list on the right — add or remove procedures, correct modifiers, correct units, and edit the diagnosis links on each line.
Check Expected Total — that number is what the payer will see. If it is $0.00, the claim will fail to submit; add prices in Charge Master first.
Set Claim Status if it changed (Ready, Hold, Flag Clinical, Needs Coding, etc.).
Click Save, or Save & Next (Ctrl+Enter) to move to the next claim in one keystroke.
Add a Biller Note if the team needs context on what you changed. Notes save separately from codes.

Button	What it does
Save	Persists code, POS, and diagnosis-pointer changes to the claim. Enabled only when you have edited something.
Save & Next (Ctrl+Enter)	Saves and jumps to the next queue row without closing the drawer.
Flag for Clinical	Marks the claim's status as Flag Clinical and sends the row back to the clinical team for review.
Edit in Full Form	Opens `/billing/new?editClaimId=…` — the same claim, expanded into the full submit page. Use it for changes the drawer does not cover (subscriber block, insurance sequence, service dates).
Close	Closes the drawer. Unsaved edits are discarded.

Coding-fact overrides are soft blocks, and they are recorded

When a code triggers a coding-fact finding — MUE unit ceilings, unusual Place of Service, mutually exclusive procedures — the submitter does not silently accept it, and it also does not refuse outright. Instead:

Submit stops, and a modal names every finding in the biller's words ("CPT 97597 units exceed CMS MUE of 3 per DOS").
You either fix the codes and try again, or confirm the override — "Submit it anyway".
If you confirm, the submission proceeds AND a row is written to claim_status_history with the method (electronic / manual / fax / resubmit), the codes overridden, and who overrode them.

The same check now runs on all four submission paths — Submit to Stedi, Mark as Submitted, Fix & Resubmit, and Send Fax — so a biller cannot walk around the electronic gate by faxing the claim off-system. Every override reads back as an attributed decision on the claim, not a silent bypass.

CMS MUE values carry known errors that MACs correct out-of-band, non-Medicare payers do not adopt them uniformly, and a Place of Service can be legitimately unusual. That is why coding-fact findings are soft, not hard — an override that is named and logged is worth more than a block that gets walked around off-system.

Result

At the end of a Coding Review session, the claim's codes match the note, the Expected Total is a real number, the status is set, and every override is attributed. The row in the Work Queue reflects the new codes on refresh (every 2 minutes, or Refresh to force). Any confirmed override reads back on the claim's history — see Submit a claim.

Troubleshooting

Symptom	Likely cause	What to do
Left panel says "No note"	The claim was created manually, or the note lives in a namespace outside the three tiers (rare after the Aug-26 fix).	Open View Full Note if the button is enabled; otherwise open the chart.
"VISIT NOT SIGNED" banner	The progress note is a draft or in-progress.	The provider must sign the note before the claim can be submitted. Use Notify on the Work Queue row.
Yellow warning about diagnosis pointers	A procedure line has no diagnosis linked, or points to a diagnosis you removed.	Reassign the pointer on the line — every line must point to at least one active diagnosis.
Expected Total is `$0.00`	The line has no price in `facility_charge_master`.	Open Charge Master for the facility and add the price. See Charge Master and the $0 claim guard.
Save button disabled	You have not edited anything, or the claim row failed to load.	Reopen the drawer, or use Edit in Full Form.

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