Hospital Chargemaster Auditor
11 of 22 claim lines have coding or pricing exceptions: $2,504.00 of compliance exposure and $1,906.00 to recover by correcting lines, plus $2,230.00 of charges above the markup policy.
E/M 99284 (line 1) and procedure 12002 (line 2, in the CPT surgery range 10004-69990) are billed on 2026-08-03, and line 1 carries no modifier 25. The E/M line is at risk of denial: $1,850.00.
Method1NCCI PTP (embedded sample subset, 5 pairs): column 1 and column 2 codes on the same claim and date. Indicator 0 is always an error; indicator 1 is an error unless a line carries 59, XE, XS, XP, XU or another NCCI-associated modifier, or the lines carry different anatomic modifiers. Edits outside their effective and deletion dates are skipped.
2MUE (embedded sample subset, 7 codes): units summed per claim and date of service, or per line when the adjudication indicator is 1. The excess units times the unit charge is at risk.
| Claim | Line | Date of service |
|---|---|---|
| OP-2608-10041 | 1 | 2026-08-03 |
| OP-2608-10041 | 3 | 2026-08-03 |
| OP-2608-10041 | 3 | 2026-08-03 |
Claim line export (CPT, modifiers, charges), plus the chargemaster
Coding exception list and recovery estimate (Coding exception list (CSV), Recovery estimate memo)
$3,500 / month, 30% to the referring partner
Read in memory for the session, never stored, never used to train a model.
Not medical, clinical, coding or regulatory advice. A qualified healthcare, coding or regulatory professional must review every result.