In 2023, I was generating more surgical volume and seeing more clinic patients than most of my colleagues at a major academic medical center. I had been doing this long enough to know what a busy practice looked like, and mine was busy. So when my wRVU total came in below the 10,000-unit threshold that would trigger my bonus compensation, I did not accept the explanation that I simply had not worked hard enough.
I started pulling my own numbers. I looked at my CPT codes, my documented encounters, and my surgical cases. I compared them to what was actually being billed and credited to my productivity. The gap was significant. I was being credited for approximately 20% fewer wRVUs than what my clinical work actually represented. The errors were not dramatic, no one was stealing from me. They were the quiet, accumulated result of documentation habits, coding defaults, and a billing system that moves fast and makes conservative assumptions when documentation is ambiguous.
Some of the problem was on the coder side. Some of it, honestly, most of it, was on mine.
What I Found When I Looked Carefully
I started documenting everything myself. For every patient I saw, every procedure I performed, every note I signed, I tracked what I believed the correct code was and compared it to what was actually submitted. I kept a running log for months. The pattern was consistent: I was regularly undercoding my E/M visits, missing add-on codes I had legitimately earned, and letting procedure documentation slide in ways that cost me wRVUs I had no reason to leave behind.
The frustrating thing was that I was not doing anything wrong clinically. I was seeing the patients, making the decisions, performing the procedures. The work was real. The credit was not following the work because the documentation was not telling the full story of what I was actually doing.
Once I understood the rules, really understood them, not just as abstractions but as they applied to my specific patients and note patterns, my numbers came up. Not because I started working harder or seeing more patients. Because I started documenting what I was already doing in a way that the coding system could accurately recognize.
Why I Built This Site
As my own numbers improved, I started talking to colleagues. Almost every one of them had the same problem I had. And almost none of them knew it. They assumed their coders had it handled. They assumed that if there were a problem, someone would have told them. They were wrong on both counts, not because anyone was being dishonest, but because nobody in the system had a specific incentive to close that gap the way I did.
I built tools to help myself first, a documentation template in your electronic record that prompted the right documentation at the right moment, a coding assistant that could score a note against the MDM criteria and tell me what level it actually supported, a calculator for fracture billing that takes all the guesswork out of a code set that most orthopaedic surgeons find genuinely confusing. Then I started sharing them with colleagues. The response was consistent: I had no idea this was how it worked.
This site exists because physicians, nurse practitioners, physician assistants, and every provider doing clinical work deserve the same quality of practical, unbiased financial education around coding that sites like the White Coat Investor have built around investing. The money you earn starts with the work you do. But it gets realized only if your documentation captures what you did. That gap, between work performed and work credited, is the problem this site is designed to close.
And there is one more reason, which might be the one I care about most. Almost everything that gets asked of providers these days is more: more patients, more documentation, more metrics, more committees. This is the rare project that asks nothing more of you. I am not asking anyone to work harder, see more patients, or stay later. I am asking you to get the credit that is already due to you for the hard work you are already doing. I appreciate that work. It is hard, it matters, and the people doing it deserve full recognition for it, both professionally and financially.
What This Site Is
A growing library of guides covering coding from the ground up, written in plain English, by a physician, for physicians, NPs, PAs, and every provider who bills for clinical work. Each guide is standalone, you can start wherever your most pressing question is. There are no paywalls, no subscriptions, and no courses to buy. The interactive tools are free.
The goal is not to get anyone to code higher than their documentation supports. That is not appropriate, and it is not what this is about. The goal is accurate coding, making sure that the work you are already doing, and the clinical complexity you are already managing, is being recognized and credited correctly. Undercoding is not safer than overcoding. It is just quieter. And it costs real physicians real money every single day.
About the Author
I am an orthopaedic sports medicine surgeon serving as Enterprise Director of Orthopaedic Informatics and Director of Sports Medicine at a major health system. I hold an appointment as Assistant Professor of Orthopaedic Surgery at VCOM and serve as Documentation Excellence Director at a major health system's Integrated Surgical Institute. My surgical training included fellowships at UCLA and work with professional sports organizations.
I received my MD CM from McGill University and completed my orthopaedic residency at the University of Toronto. I hold board certifications through both the Royal College of Surgeons of Canada (FRCSC) and the American Board of Orthopaedic Surgery (FABOS, FAAOS). I have performed humanitarian surgical work in Botswana, Malawi, and Ecuador.
My academic interests include surgical education, documentation optimization, health systems innovation, and the intersection of clinical informatics and physician productivity. The coding education and documentation optimization program I developed across a major health system's orthopaedic division covered 39 months of outpatient data and approximately hundreds of thousands of encounters. A peer-reviewed manuscript documenting the financial and productivity impact of that program is currently in preparation for submission.
Michael MacKechnie MD CM FRCSC FABOS FAAOS
Get in touch
Questions, feedback, corrections, or a suggestion for a guide that should exist are all welcome. Use the contact page to send a note. Messages come straight to me, and reader feedback genuinely shapes what gets written next.