E&M coding is a revenue integrity and compliance indicator because it sits where clinical documentation, payer behavior, and audit scrutiny collide. When the system around E&M coding is weak, the symptoms show up everywhere. Notes do not support the billed level, provider selected codes go out without a review net, templates introduce systematic risk, and query volume slows billing while increasing cost to collect. Downstream, payers apply edits and downcoding logic, denials and appeals multiply, underpayments hide in plain sight, and coding patterns can quietly raise audit exposure.
This Office Hours session is structured around ten breakpoints that determine whether E&M coding is accurate, efficient, and defensible. For each breakpoint, the panel will discuss what it looks like, what it costs in time, revenue, and risk, and what fixes actually improve outcomes. The discussion will also address where AI and autonomous E&M coding can help when paired with human specialist exception handling, including pattern detection by provider, documentation quality signals, and exception based review models that scale oversight without sacrificing defensibility.
Learning Objectives
- Identify the ten breakpoints that most often drive downcoding, denials, underpayment, and audit exposure in E&M coding
- Apply practical fixes that reduce rework, improve documentation support, and strengthen revenue integrity across the E&M coding lifecycle
- Explain how AI supports better RCM outcomes through pattern detection, documentation review, exception based workflows, and autonomous E&M coding with specialist exception handling
Thursday, March 5, 2026, 11:00am PT / 1:00pm CT / 2:00pm ET