The Library

All Guides

Five collections, in reading order. New here? Start with Foundations, then The Office Visit. Every guide opens with the bottom line and ends with the tool that puts it to work.

The bottom line
Five collections in reading order; every guide opens with the bottom line and ends with the tool that puts it to work.

Foundations

How payment works, and how the current rules decide every visit level.

Foundations 1
Why Coding Matters: The Direct Line From Your Notes to Your Paycheck
Your notes, not your effort, decide your credit. Learn the rules once and they pay you every clinic day after.
Foundations 2
How Physicians Get Paid: wRVUs, Conversion Factors, and the Fee Schedule
A wRVU is the work unit behind your paycheck. Multiply it by a conversion factor and you have your income math.
Foundations 3
The 2021 E/M Revolution: Why the Rules Changed and What It Means for You
Since 2021, only medical decision making or total time sets the office visit level. History and exam no longer count it.
Foundations 4
Medical Decision Making Decoded: A Practical Field Guide
MDM has three columns: problems, data, and risk. The visit level is whatever two of the three support.
Foundations 5
The Problems Column: Counting What You Actually Addressed
Count every problem you actually assessed or managed today, and label chronic problems by whether they are at goal.
Foundations 6
The Data Column: Getting Credit for the Records You Review
Data credit comes from unique tests, outside records, historians, your own reads, and real discussions, counted the right way.
Foundations 7
The Risk Column: The Easiest Column to Support
Risk is usually the easiest column: a prescription managed is already moderate.
Foundations 8
Choosing Your Level of Service: Common Mistakes and How Auditors Think
Most level errors come from one habit: coding the diagnosis instead of the decision making. Auditors read the columns.

The Office Visit

The moves that set the level, and the add-on codes most providers skip.

The Office Visit 1
Modifier 25: The Most Valuable Two Digits in Medicine
Modifier 25 pays you for real evaluation work on a procedure day, but the workup that leads to the procedure never counts.
The Office Visit 2
Modifier 59 and the X Modifiers: Distinct Procedural Services
Modifier 59 and the X set separate procedures that would otherwise bundle. Use the most specific modifier that fits.
The Office Visit 3
G2211: The Add-On Code Most Eligible Physicians Aren't Using
G2211 adds 0.33 wRVU to most longitudinal office visits, and most eligible providers still skip it.
The Office Visit 4
Coding by Time: When to Use It and How to Document It Correctly
Total time on the date of service can set the level by itself. Document the exact minutes, never a range.
The Office Visit 5
Preventive Visits and Same-Day E/M: Getting Both Right
A preventive visit and a problem visit can share a day when the problem work stands on its own. Code both.
The Office Visit 6
Prolonged Services: Capturing Time Above the Threshold
Past the top level, every documented 15 minutes is a prolonged services unit most providers never claim.
The Office Visit 7
Consultation Codes: Who Still Uses Them, When, and What Medicare Does Instead
Commercial payers still pay consultation codes, and they pay better. Medicare wants new or established codes instead.

Prevention, Compliance, and Practice Rules

Wellness visits, telehealth, audit-proof documentation, and who codes under whom.

Prevention 1
Incident-To Coding: Rules, Risks, and the Supervision Trap
Incident-to lets APP visits pay at 100 percent only under strict supervision rules. Break one and it is 85.
Prevention 2
Medicare Annual Wellness Visits: The Most Misused Code in Primary Care
The AWV is not a physical. It is a structured wellness service with its own G codes and its own rules.
Prevention 3
AWV + E/M on the Same Day: A Step-by-Step Guide
An AWV and a real problem visit on the same day are both codable when the note separates the work.
Prevention 4
Documentation as Armor: What a Compliant Note Looks Like Under Audit
A compliant note states what you considered, what you decided, and why. That is what an auditor reads for.
Prevention 5
Diagnoses, Comorbidities, and the Codes Physicians Forget to Document
Comorbidities you manage belong in the assessment. Documented, they raise complexity honestly.
Prevention 6
AI and documentation templates: Making Better Coding Automatic
Templates and AI drafts make good coding automatic when they prompt the facts that actually set the level.
Prevention 7
Advanced Practice Providers: The 85 Percent Rule and What It Means
APP work pays at 85 percent under their own number and 100 under incident-to. The rules pick the number.
Prevention 8
Counseling Services: Tobacco, Obesity, and the Work You Give Away
Three minutes of documented tobacco counseling is a code. You already do the work; write the minutes.
Prevention 9
Telehealth: Coding Visits That Are Not In Person
Telehealth has its own code families and payer splits. The medium changes the code, not the medicine.

Specialty Playbooks

The code families that run each field.

Specialty Playbooks 1
Orthopaedic Surgery Coding: E/M, Global Periods, and the Surgical Visit
Orthopaedic income lives in the global period rules: know what the package includes and what escapes it.
Specialty Playbooks 2
Nonoperative Fracture Care: The 90-Day Global and How to Code It
Nonoperative fracture care is a 90 day package worth several visits. Code it once, correctly, with the modifier 57 logic.
Specialty Playbooks 3
Sports Medicine Procedures: Injections, Aspirations, and Commonly Missed Codes
Injections and aspirations carry their own codes and wRVUs. The most missed are small joints and guidance codes.
Specialty Playbooks 4
Sports Physicals and Pre-Participation Exams: How to Code Them Correctly
A sports physical is usually a preventive code, not an E/M, and the payer decides the exact lane.
Specialty Playbooks 5
The 25 Codes That Pay Primary Care
Twenty five codes generate most of primary care wRVUs. Know their values cold.
Specialty Playbooks 6
Emergency Medicine Coding: Levels, Critical Care, and the 2023 Reset
ED levels run on MDM alone, time never applies, and critical care is its own better paying lane.
Specialty Playbooks 7
Behavioral Health Coding: Therapy Time, E/M Add-Ons, and the Two-Service Visit
Prescribers can code an E/M and a therapy add-on in the same visit when the time is separated.
Specialty Playbooks 8
Hospitalist Coding: Admissions, Subsequent Visits, and the 2023 Observation Merger
The 2023 merger folded observation into inpatient codes. The admission day and the discharge rules carry the money.
Specialty Playbooks 9
General Surgery Coding: The Global Package and the Modifier Family That Runs It
The global package decides what surgery already includes. The modifier family decides what still pays.
Specialty Playbooks 10
Surgical Coding Overview: The Global Package and Its Exceptions
Every operation carries a package of included care. The exceptions, coded right, are the additional credit.

Coding Questions, Answered Directly

One question per page, answered in the first paragraph, with the documentation that holds up.

Question 1
99213 vs 99214: What Actually Separates Them
The two of three rule, the three everyday level 4 patterns, and the time thresholds.
Question 2
G2211 Documentation Requirements
The longitudinal relationship rule, the modifier 25 exclusion and its wellness visit exception, and the one sentence attestation.
Question 3
Modifier 25 With a Joint Injection
When an office visit is also payable on an injection day, and what never counts.
Question 4
Modifier 57 for Fracture Care
The decision for surgery rule, why closed treatment counts as major, and 57 versus 25.
Question 5
Can CPT 29877 Be Coded With 29881?
Why chondroplasty bundles into meniscectomy, and the Medicare G0289 exception.
Question 6
Can CPT 29826 Be Coded With 29827?
Yes, as an add-on, when the acromioplasty work is documented; here is the language.

Your Numbers

Find the gap, track it, close it.

Your Numbers 1
Undercoding: Why Most Physicians Leave Money on the Table and Don't Know It
Most providers undercode 15 to 30 percent of their E/M work. The gap is systematic, measurable, and fixable.
Your Numbers 2
Building Your Personal Coding Dashboard: Track Your wRVUs and Find the Gaps
Pull your own code distribution once a quarter. The shape of the curve tells you exactly where the gap is.
Your Numbers 3
References and Further Reading
The primary sources behind this site, worth bookmarking.