Specialties
Pick a specialty for top-billed codes, common visit scenarios, and modifier rules tailored to that practice setting.
The bread and butter: established office visits, new-patient workups, complex chronic disease bundles, and wellness add-ons. The codes that move primary care RVUs are E/M time/MDM, G2211, and the wellness stack.
Heavy on Medicare wellness, chronic care management, transitional care, advance care planning, cognitive assessment, and SDOH. These are time-based codes with strict documentation; getting the documentation right turns 20 minutes of phone work into real RVUs.
Mixed E/M plus high-volume diagnostic procedures: EKGs, echos, stress tests, Holters, device interrogations, vascular ultrasound. Most cardiology procedures split into professional, technical, and global components.
Cognitive specialty, mostly E/M. Procedural revenue comes from CGM interpretation, thyroid ultrasound and biopsy, and MNT supervision. CGM coding is a regulatory layer cake — get the time, sensor source, and patient setup right or the claim gets denied.
Procedure-heavy. Most outpatient GI revenue comes from upper and lower endoscopy with modifier-driven add-ons (biopsy, polypectomy, dilation). Screening vs diagnostic coding has different patient cost shares and modifier rules.
Office spirometry, pulmonary function testing, bronchoprovocation, sleep medicine. Spirometry is one of the most under-coded ancillaries in primary-care-adjacent practices because the bronchodilator add-on gets forgotten.
ESRD monthly capitation drives outpatient nephrology revenue (MCP, 90951-90970), plus CKD E/M, vascular access procedures, and home dialysis training. MCP coding is age-stratified and visit-frequency stratified.
Cognitive specialty with high-yield joint and soft tissue injections, plus chronic infusion management. Joint injection coding is anatomic-site stratified, and ultrasound guidance is its own bundled code.
Almost entirely cognitive. Revenue depends on accurate complexity coding (99214/99215 with G2211), outpatient infusion management, and prolonged service coding for long visits. Antimicrobial stewardship rounds are not billable.
Infusion-driven revenue dominates: chemotherapy administration codes are time-stratified and drug-type stratified, with strict hierarchy rules. Cognitive E/M with G2211 is critical for survivorship and chronic disease management.
Cognitive specialty with high-RVU diagnostic procedures: EEG, EMG/NCS, evoked potentials, cognitive assessment. Most procedures split into professional and technical components. Cognitive assessment care plan (99483) is one of the highest-RVU outpatient codes in medicine.
Three revenue pillars: percutaneous and intradermal allergy testing (per-test billing), immunotherapy preparation and administration (95115-95170), and biologic injection management. Testing codes are billed per-test, so unit counts matter.
The hospitalist stack: initial inpatient/observation admission (99221-99223), daily subsequent visits (99231-99233), discharge day (99238-99239), same-day admit/discharge (99234-99236), inpatient consults (99252-99255 for commercial payers), and critical care (99291-99292) when the patient is critically ill. Documentation hinges on MDM elements or total time on the date of the encounter. Watch the time-vs-MDM choice and the prolonged-service add-on (G0316 Medicare, 99356/99357 deprecated).
Radiology is the highest-volume billable specialty in U.S. medicine, and the rules are not negotiable. The defining concept is the global vs professional vs technical (26 / TC) split: hospital-based radiologists bill the professional component only (modifier 26), freestanding imaging centers bill global, and independent diagnostic testing facilities (IDTFs) bill technical only (modifier TC). Most denials trace back to a setting-modifier mismatch. Beyond that, every modality has its own landmines: contrast tiers (without, with, or without-and-with are three different codes), the CT abdomen-and-pelvis bundle (74176 / 74177 / 74178 supersedes billing CT abdomen plus CT pelvis separately), multi-procedure reduction on the technical component, and the screening-versus-diagnostic distinction in mammography with cost-share waiver modifiers. Subspecialty rules layer on top: PET-CT staging codes (78815 / 78816 / 78814) are anatomy-stratified, MPI codes (78451 / 78452) are study-count stratified, and interventional radiology stacks selective catheter codes (36245 / 36246 / 36247) with imaging guidance codes (76942 / 75710 / 75716) per vascular territory.