Is It Time to Hire a Coder? A Guide for Small Practices

Small practices, typically made up of one to five providers, often find themselves needing to be fiscally conservative and operationally adaptable. But when it comes to coding and billing, those traits can sometimes lead to short-term solutions that create long-term problems. Coding isn’t just about selecting the right CPT or ICD-10 code, it’s about understanding regulatory requirements, supporting documentation, and preserving the integrity of the revenue cycle. As a result, many practices face the same important question: Is it time to bring a coder in-house?

Let’s break that down. Because the answer doesn’t rest solely on practice size, but on the services provided, the complexity of coding requirements, and the risks tied to getting it wrong.

Pros and Cons of Hiring a Coder In-House

As with any business decision, the pros and cons should be considered when adding an additional operational expense. For small practices navigating limited resources and increasing documentation demands, understanding both the benefits and the limitations of bringing coding in-house is essential.

Pros:

1️⃣ Real-Time Support: An in-house coder can offer immediate feedback, help clarify documentation before it leads to denials, and promote accurate claim submission from the outset.

2️⃣ Improved Internal Communication: Coders embedded in the practice better understand team workflows, clinical terminology, and operational goals, enhancing collaboration. 

3️⃣ Proactive Compliance Monitoring: Having someone on site allows practices to identify trends and resolve issues before they trigger audits or revenue loss.

Cons:

1️⃣ Cost Considerations: Hiring a full-time coder brings salary and training expenses that can be difficult for a lean-budget practice to justify.

2️⃣ Recruitment Challenges: Especially in underserved regions, it can be difficult to find qualified coders who understand both the specialty and the payer environment.

3️⃣ Scope of Expertise: A single coder may not be equipped to handle multiple service lines and specialties without additional training and support.

Regardless of who is doing the coding, the responsibility for submitted claims ultimately falls to the rendering provider. That’s why physicians and advanced practice providers must have a fundamental understanding of coding principles and documentation standards.

You cannot code your way out of poor documentation. And no matter how skilled your coder is, they cannot assume clinical intent. The provider’s documentation must clearly support the services billed. In the event of an overpayment or audit, it’s the provider’s name on the letter.

Therefore, an emphasis should be placed on responsibility and awareness. Provider engagement in the coding process is essential, because when that engagement is present, outcomes measurably improve.

Combination Role

For many small practices, combining the roles of coder and biller into one position feels like a natural fit. It can streamline workflows, save on staffing costs, and improve communication across the billing cycle. However, this arrangement comes with its own set of considerations, and practices must weigh the risks against the rewards before moving forward.

Rewards of a Dual Role:

•         It can be a cost-effective staffing solution, especially for practices operating with tight budgets.
•         Communication and workflow may be more seamless when one person handles both the coding and billing components.
•         A single point of responsibility can lead to quicker claims processing and fewer handoffs or delays.
•         With the right knowledge base, the dual role can foster a deeper understanding of the entire revenue cycle process.

Risks of a Dual Role:

•         Without separation of duties, errors in coding may go undetected, particularly if no secondary review process is in place.
•         The lack of peer review increases the risk of non-compliance and missed audit vulnerabilities.
•         One person juggling both tasks can lead to burnout or decreased focus on the details each function requires.
•         There may be limited time or resources for continuing education, which is critical in both disciplines.

Success in a combination role hinges on the skill, training, and accountability of the individual filling it. Practices choosing this route must ensure that proper safeguards—such as internal reviews and ongoing education—are in place to support accuracy and mitigate risk.

Is a Certified Coder Necessary?

While certification can be a helpful benchmark, it should not be the sole measure of a coder’s capability. Certification indicates that a coder has demonstrated general knowledge and is prepared to meet baseline industry expectations, but it does not always reflect the depth of applied understanding needed in a real-world, specialty-specific setting.

What truly matters in a small practice is a coder’s ability to interpret, apply, and adapt coding guidelines to your services, documentation styles, and payer requirements. The difference lies in how well they translate rules into practice, not just whether they passed an exam.

Whether certified or not, a strong coder brings working knowledge, critical thinking, and an ongoing commitment to learning—because coding isn’t static. Rules change, payer policies shift, and complexity grows. The right coder is the one who keeps pace and brings practical expertise to the table.

Investing in applied knowledge, supported by continuing education and specialty-specific training, is far more impactful than focusing on credentials alone.

Is It Time to Make Room for a Coder?

Hiring a coder is not just a matter of how many patients you see. It’s about whether the complexity of your services demands a higher level of oversight, accuracy, and coding support. Practices should begin by evaluating their current pain points and the nature of the services they provide. If coding questions are common, denials are increasing, or documentation reviews are highlighting gaps, those are signals to reassess your current structure.

Ask yourself the following:

 Are you performing procedures in-office that require modifier usage or global period tracking?

•         Are you billing for care management services such as CCM or TCM, or regularly reporting higher-level E/M?
•         Are you involved in shared or split services, requiring careful attribution and documentation alignment?
•         Do you routinely submit claims with modifiers, add-on codes, or specialty-specific requirements?

If these scenarios are part of your routine, the demand on your coding process is high.

That level of complexity is a strong indicator that it may be time to bring a coder in-house—or at minimum, secure dedicated coding expertise. The decision should be based on the services you provide, the rules those services trigger, and the risk that comes with getting them wrong.

Ultimately, it’s about supporting compliance, protecting reimbursement, and setting up your practice to grow with confidence and clarity. 

The business side of healthcare doesn’t allow for guesswork. Accuracy, documentation integrity, and timely reimbursement all depend on a clear strategy for coding and billing.

Small practices can succeed with internal coders, external support, or a hybrid model—but that decision must be intentional. At the end of the day, a coder can guide the process, but the provider always remains responsible.

Contact Us