7 Coding Mistakes That are Quietly Costing Your Practice
Revenue loss in primary care is often driven by everyday coding and documentation habits. These seven common mistakes can lead to reduced legitimate reimbursement without physicians realizing it.
2. Not billing based on time when time is clearly supported
Time-based E/M coding is allowed when total time spent by the physician or qualified health professional on the date of the encounter meets the requirements for a given visit level. This includes both face-to-face time and certain non-face-to-face work performed that same day, such as reviewing records, documenting, and coordinating care.
Despite documenting total time, many clinicians still default to medical decision-making or select a lower-level code. This is especially common during visits involving extensive counseling, complex chronic disease management, or coordination with outside providers.
Source: Austin Littrell, Physicians Practice [12/15/25]
