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Staffing & Resource Augmentation

We provide experienced RCM, HIM, coding, and CDI professionals, onshore and offshore.

Staffing & Resource Augmentation

We provide experienced RCM, HIM, coding, and CDI professionals, onshore and offshore.

Staffing & Resource Augmentation

We provide experienced RCM, HIM, coding, and CDI professionals, onshore and offshore.

Staffing & Resource Augmentation

We provide experienced RCM, HIM, coding, and CDI professionals, onshore and offshore.

How Concurrent Coding Increases E/M and Procedure Volume by 26%

Does Concurrent Coding Really Increase E/M and Procedure Volume by 26%?

Yes, and not because organizations are “coding more aggressively,” but because they’re finally capturing the full clinical story at the right time.
Healthcare organizations that implement concurrent coding consistently report double-digit improvements in E/M level accuracy and procedure capture, with many seeing up to a 26% increase in E/M and procedure volume compared to retrospective-only models. The improvement comes from real-time documentation clarification, earlier CDI intervention, and reduced information loss between care delivery and coding.
Real-time E/M capture

In simple terms:
When coding happens while care is still happening, less revenue leaks out.

This is why concurrent coding has become a strategic priority for CDI, HIM, and RCM leaders focused on sustainable margin improvement not short-term gains.

Why Does Timing Matter So Much in Coding and CDI?

If you’ve been in revenue cycle leadership long enough, you’ve seen this pattern play out repeatedly.

Documentation is completed under pressure.
Details are implied but not stated.
Complexity is clinically obvious but not codified.

By the time retrospective coding begins:
  • Providers have moved on
  • Context is lost
  • Queries become harder to answer accurately
Concurrent coding solves this by intervening while the encounter is still clinically alive.
Concurrent coding improves documentation completeness and accuracy because coders and CDI specialists can address gaps before discharge, not weeks later.

That single shift in timing is what unlocks higher E/M and procedure volume compliantly.

How Exactly Does Concurrent Coding Increase E/M Volume?

It captures complexity that retrospective coding often misses

E/M coding depends heavily on:
  • Medical decision-making (MDM)
  • Risk to the patient
  • Clinical judgment
When documentation lacks clarity, coders default to conservative levels.
Concurrent coding changes that are dynamic by:
  • Allowing CDI teams to clarify MDM in real time
  • Supporting providers while documentation is still editable
  • Reducing assumptions and coder interpretation
Real-time documentation review significantly improves E/M accuracy and reduces under-coding caused by unclear clinical intent
For you as a leader, this means E/M levels better reflect the care your clinicians are already delivering.

Why Does Procedure Volume Increase with Concurrent Coding?

Procedures aren’t missed, they’re clarified

Procedure under-capture usually isn’t intentional. It happens when:
  • Details are split across multiple notes
  • Laterality or approach isn’t explicit
  • Supporting documentation is incomplete
Concurrent coding allows:
  • Immediate identification of missing elements
  • Clarification before operative notes are finalized
  • Confirmation of billable procedures while documentation is fresh
ForeSee Medical reports that concurrent coding significantly reduces missed procedure capture by addressing documentation gaps early in the care process
That’s how procedure volume increases not by adding services, but by accurately reflecting what already occurred.
Documentation and revenue gains

What Are Other Organizations Actually Seeing After Implementation?

This is where concurrent coding moves from theory to reality.

Measurable documentation and revenue cycle improvements

Industry data shows:
  • Up to 76% improvement in documentation quality
  • 20–25% reduction in documentation-related denials
  • Faster claim submission and reduced DNFB days
Organizations using concurrent coding experience significant reductions in rework and denials due to improved upfront documentation
For RCM and finance leaders, this translates into:
  • More predictable revenue
  • Lower cost to collect
  • Fewer downstream surprises

Does Concurrent Coding Create Compliance Risk?

This is a fair concern, especially for CFOs and HIM leaders.

In practice, it often reduces risk

When implemented correctly, concurrent coding:
  • Strengthens documentation before claim submission
  • Reduces retrospective queries that feel “leading”
  • Improves audit defensibility with clearer clinical narratives
Because documentation and coding are aligned before billing, organizations are often better positioned during payer audits than those relying heavily on retrospective correction.

Concurrent coding doesn’t push codes higher it makes them defensible.

What Role Does Technology Play in Making This Sustainable?

Manual concurrent coding alone doesn’t scale.
That’s why leading organizations pair it with:
  • AI-assisted documentation gap detection
  • NLP-driven chart prioritization
  • EHR-embedded CDI and coding workflows

These tools help teams focus on high-impact encounters, improving productivity without increasing staff burden.

According to multiple health IT analyses, AI-supported concurrent coding improves first-pass accuracy and reduces chart review time, both critical for sustained performance improvement

Is Concurrent Coding a “Nice-to-Have” or a Strategic Priority?

If you’re facing:
  • Flat E/M yield despite rising acuity
  • Increasing payer scrutiny
  • Provider frustration with late queries
  • Margin pressure without room to cut care
Then concurrent coding is no longer optional.
It’s one of the few strategies that improves:
  • Revenue integrity
  • Compliance confidence
  • Provider collaboration
all at the same time.
Where E/M revenue is lost
Capture docs while care happens
Retrospective coding misses context
CDI improves E/M accuracy
Procedures clarified early
Up to 26% E/M gain
Fewer denials, faster claims
Tell story while written

How Real-Time Clinical Storytelling Drives Sustainable Revenue Integrity

Concurrent coding works for one fundamental reason:
The best time to tell the clinical story is while it’s still being written.
When documentation reflects complexity in real time:
  • E/M levels rise appropriately
  • Procedures are captured accurately
  • Revenue aligns with care delivery

That’s how organizations achieve a 26% increase in E/M and procedure volume, not through aggressive coding, but through better timing, collaboration, and documentation.

And that’s not a tactical fix.
That’s a leadership decision.

Author Bio:

Kanar Kokoy

CEO - Chirok Health

Healthcare CEO & CDI/RCM innovator. I help orgs boost accuracy, integrity & revenue via truthful clinical docs. Led transformations in CDI, coding, AI solutions, audits & VBC for health systems, ACOs & more. Let’s connect to modernize workflows.

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