3 Physician Billing & Coding Mistakes to Avoid
Posted Feb 17, 2025
Billing and coding are where physicians quietly lose — or protect — a large share of their income. These are the three most costly mistakes I see physicians make, and why mastering medical decision making is the key to getting paid accurately for work you already do.
Mistake #1: Weak Knowledge of Billing and Coding
I'm fortunate to work with residents and fellows, and I often turn a clinical encounter into a quick exercise: "How would you charge for this visit?" They treat it like an intriguing exam question — but the answers reveal how little formal training we get in coding. Most default to a gut feeling: "This looks like low complexity," or "This feels high complexity." And a wrong guess isn't harmless — over a career, it costs real money.
Coding isn't approximate. It's not "one plus one equals two" — it's "1.0 plus 1.0 equals 2.0." The criteria are that specific, and knowing them precisely is what protects your income. A patient with ten problems might feel complex yet only meet moderate complexity, while a single problem described in one short paragraph can legitimately qualify as high complexity. New patient or established, the rule is the same: know the ins and outs, and code to the criteria — not to your impression.
Mistake #2: Billing by Time Instead of Medical Decision Making
The common question is whether it's more profitable to bill by time — put the minutes down, defend it in an audit, and move on. In my honest opinion, billing by time is a waste of time. Billing by medical decision making (MDM) will take you far further, if you know the guidelines.
The math favors MDM. As of 2025, billing high complexity by time for a new outpatient requires more than 60 minutes; for an established outpatient, more than 40 minutes. But by MDM, I can see a patient in 10–15 minutes — sometimes as few as 5 — and legitimately bill high complexity when the encounter meets the criteria. If you understand your coding, time-based billing leaves money on the table. Learn MDM, and code it with confidence.
Mistake #3: Not Tracking Your Daily Numbers
Knowledge is power, and so is data. So ask yourself: Do you know how many patients you see each day? Your average charge level — how often you code low, moderate, or high? Which factors actually move your productivity?
We already practice evidence-based medicine — we read the literature, interpret statistics, and spot trends. Apply that same rigor to your own practice. And I don't mean the quarterly CPT summaries your service-line leader or clinic manager sends. I mean day-to-day data you track yourself. That granular, personal record is what lets you see your real trends and make deliberate decisions — and it can transform how you run your practice.
The Bottom Line
Three mistakes to avoid: coding by feel instead of criteria, leaning on time-based billing when MDM pays better, and flying blind without your own daily numbers. Fix those three, and you protect income you're already earning.
Want the system? Physician Revenue Mastery walks through coding, MDM, and the exact revenue-tracking sheet I use every day — CME-accredited and built for practicing physicians.
References & Further Reading
American Medical Association — Medical coding mistakes that could cost you: https://www.ama-assn.org/practice-management/cpt/medical-coding-mistakes-could-cost-you
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