On coding and curiosity: Hunting for gold in the numbers your practice already generates

Practice administrators may be missing out on gold hidden in the medical coding numbers that track physician treatment of patients.

Hidden gold, in the form of increased revenue, is not necessarily hard to dig up if practice leaders can compare codes used, and get coders and doctors to talk to each other.

The tactics were part of “What’s Hiding In Your Data? Using the Right Data to Discover Hidden Revenue Opportunities,” a Sept. 29 presentation by Barbara L. Ireland, FACMPE, at the 2026 annual leadership conference of MGMA, the Medical Group Management Association.

One instance of discovery, retraining staff and rebilling insurers led a pediatric group to gain an additional $250,000 a year by crunching numbers from work already being performed, without adding new staff or software.

“The opportunity existed because of a coding habit that nobody had questioned, and had only been recognized because someone was looking at the data,” said Ireland, a senior operations analyst at Murfreesboro Medical Clinic.

While not a trained analyst, the 20-year administrator and immediate past president of Tennessee MGMA described herself as someone who loves playing with numbers and asking, “why?”

Her examples used altered names, she said, but real results. Her message for administrators was that the tools are ordinary: Microsoft Excel, the PivotTable spreadsheets it can create, and curiosity. What matters is the habit of noticing variation, asking why it happens, and refusing to accept the first explanation.

“It’s not about knowing all the answers. It’s simply about knowing how to find them,” she said.

What report do you need?

Ireland starts with fields almost any practice management system can export, including medical record number, date of service, physician, place of service, department, Current Procedural Terminology (CPT) code and description, units, modifiers, payer, charges, payments and adjustments.

“If you can’t, you need a different system,” she said.

She builds an Excel pivot table filtered by time period, with providers as rows, CPT codes as columns and units as values. She includes each code’s description but narrows the columns so only the code shows. Excel handles far more data than most people use — one spreadsheet can hold more than 1 million rows — and she said it remains her go-to tool despite fancier options.

What should you look for?

Ireland presented slides that laid out a sequence administrators can follow:

• Find variation among providers in the same specialty who see similar patients.
• Zoom in on codes most providers use but a few rarely or never bill.
• Ask why, and don’t stop at the first answer.
• Find the high performer who has already solved the problem and can teach colleagues.
• Compare each provider’s current year with the prior year, such as steady visit volume but a sudden drop in screenings.
• Check “partner codes” that should travel together, like vaccines and their administration codes.
• Then research the cause, share what you find and measure the results.

Some questions need two pivot tables. To see whether physicians were billing evaluation and management (E/M) services with well visits when extra work was performed, Ireland built one table showing what was actually billed and another showing what patients were scheduled for, then compared them.

How do you get physicians and coders to talk?

Many of the problems uncovered were communication gaps, not knowledge gaps, Ireland said. Coders told her they skipped codes because a physician didn’t select them, because they had been told years earlier not to bill them or because the dollars seemed too small. Some feared getting in trouble.

Meanwhile, physicians assumed coders would catch their misses. In the vaccine case, one coder later told Ireland she had wondered about the two-component limit but wasn’t comfortable challenging it.

Ireland cited American Medical Association (AMA) guidance to clarify roles: The provider is responsible for documentation and ultimately a correctly coded claim, while the coder accurately translates that documentation into codes.

Her answer was a two-page physician/coder partnership agreement. It is not a legal contract but a communication tool that defines each side’s responsibilities and records each physician’s preferences. Physicians and coders and can answer questions such as: Should the coder change a code, change it and explain, or leave it alone? If a well visit note also supports an E/M code, should the coder add it, skip it or use it as a teaching moment? Should communication come by task, email or electronic chat? Ireland offered to share her template with attendees.

She also recommended regular coder meetings built around curiosity questions such as what trends coders are noticing and which codes they are using more or less often. Periodic workgroup sessions, where coders review real cases together, help them learn how peers interpret the rules.

“If they don’t feel comfortable speaking up, you’ll never hear about the opportunities they may be seeing,” Ireland said.

How do you get physicians to change?

In short: Show them the money. When some pediatricians declined to bill a depression screening code because the screen seemed too easy or patients complained about the charge, Ireland sent a brief “just an FYI” email with the charge, payer allowables and patient cost. For most patients, the charge was miniscule and more physicians started billing it, adding about $57,000 a year.

“Numbers remove emotion from difficult discussions,” she said.

Ireland also suggested asking physicians try a new routine for a month, with the option to switch back, and checking in often before frustration builds. Administrators should rerun the analysis later to confirm a change stuck and to analyze results. In the group that rarely billed E/M services with well visits, a follow-up a year later showed about $80,000 in added annual revenue.

Where else do errors hide?

New hires deserve early monitoring, Ireland said, citing examples from her experience. One new physician billed a much larger share of lower-level visits than her peers because she thought she couldn’t bill E/M services for patients referred for procedures, and her new coder wasn’t comfortable questioning it. Ob-gyn coders assumed depression screenings were included in global packages. Other coders dropped CPT 99459, which Ireland said helps cover the added cost of Pap smears, assuming it must be bundled.

Physicians can carry outdated rules, too. One told Ireland he had been coding based on information he received from a hospital more than 10 years earlier.

Ireland urged leaders to have coders research payer policies continually, because payers change them without clear notice, and not to hold denial rates against coders.

What’s the payoff?

Ireland shared sample annual results from practices she worked with, each achieved without added staff:

• About $200,000 from correct use of the G2211 visit complexity code.
• About $57,000 from a same-day newborn evaluation and discharge code coders hadn’t known about.
• About $56,000 from a workflow change at vaccine-only visits paid at an average of $128 with physician counseling vs. $56 without. Many physicians decided to have nurses alert them when a child came in only for shots, then briefly counsel the parent and document it. Another plus for patient experience: They liked seeing their physician again.
• About $53,000 from correcting a pediatric hearing test that had been billed under the wrong code because a past manager said to use it.

“What's the common thread? A simple report, a pivot table, and a willingness to ask questions. The opportunities are already there. Someone just has to notice them,” Ireland said.

She also encouraged groups to submit CPT utilization data to MGMA DataDive to benchmark against peers, many of whom already use newer codes for care outside the visit.

Physicians Practice is in San Antonio at the MGMA Annual Conference, Sept 27-30, celebrating 100 years of MGMA, attending sessions and speaking with industry leaders. Follow our coverage on our MGMA conference page.