I do mainly video game cross stitch, but everything is geeky/nerdy. Similar to Gnot Thorne, I do all of my patterns by hand. I do colour selection by eye which can lead to a lot of second guessing myself, but in the end I am pretty happy with the results. I sometimes revisit my colour choices and test for better ones.
I don't do a lot of pixelating of larger images myself as I try to stay true to the original sprites. That said, I have been able to reduce some pieces to a reasonable size for sewing. I haven't really been asked to digitize anything so I'm not sure what I would charge. I don't know if I would, outside of sewing it myself first. I don't feel confident enough with my colour choices unless I actually worked on the piece through to finish.
I've thought about buying a program to digitize patterns for me but I since I'm trying to keep enjoying the craft-as-a-second-"job" thing, I still do it by hand.