Sample audit · Fictional data
Family Medicine · 3 providers · 48 encounters analyzed
This is what a practice sees after an EarnedMD audit: supported revenue opportunities, compliance risks where the billed code may not be supported, and the clinical evidence behind every finding.
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Potential Revenue Identified
$14,280.00
Total estimated value of supported opportunities
High Confidence Revenue
$9,460.00
High-confidence supported opportunities
Encounters Analyzed
48
Opportunities Identified
19
Avg Opportunity / Encounter
$297.50
Approved for Billing
6
Findings approved and ready to capture
| Provider | Encounter | Opportunity | Est. Revenue | Confidence | Status |
|---|---|---|---|---|---|
| Dr. Sarah Mitchell | ENC-2026-0418 | E/M Level Opportunity Supported Opportunity | $102.00 | 92%High | New |
| Dr. James Park | ENC-2026-0522 | Add-On Code Opportunity Supported Opportunity | $79.00 | 88%High | New |
| Dr. Elena Rodriguez | ENC-2026-0711 | Modifier Opportunity Supported Opportunity | $39.00 | 68%Medium | Under Review |
| Dr. Sarah Mitchell | ENC-2026-0901 | Diagnosis Specificity Documentation Opportunity | — | 61%Medium | New |
| Dr. James Park | ENC-2026-1033 | E/M Level Opportunity Compliance Risk | — | 84%High | New |
| Dr. Elena Rodriguez | ENC-2026-1156 | Missed CPT Code Supported Opportunity | $28.00 | 90%High | Accepted |
Here's what a reviewer sees when they open an opportunity — the full clinical encounter on the left, and every supported finding with evidence on the right.
Dr. Sarah Mitchell · File: mitchell_encounter_418.txt · Encounter: Sep 12, 2026 · Analyzed: Sep 28, 2026
Total Potential Revenue
$141.00
2 findings
ENCOUNTER NOTE — Office Visit Date of Service: 09/12/2026 Provider: Dr. Sarah Mitchell, MD Patient: [De-identified] CHIEF COMPLAINT: Follow-up for type 2 diabetes, hypertension, and lower back pain. Patient reports increased thirst and fatigue over the past two weeks. HISTORY OF PRESENT ILLNESS: 64-year-old established patient presenting for management of type 2 diabetes mellitus, essential hypertension, and chronic low back pain. Patient reports polyuria and fatigue despite current metformin regimen. Reports back pain has worsened, radiating to the right leg, worse with prolonged sitting. Denies numbness or weakness. Blood glucose logs show fasting readings ranging 160-210 mg/dL over the past two weeks, up from prior baseline of 130-150. REVIEW OF SYSTEMS: Constitutional: Reports fatigue. No fever, no weight loss. Cardiovascular: No chest pain, no palpitations, no edema. Neurological: No focal weakness, no numbness. Negative for bowel/bladder dysfunction. Musculoskeletal: Lower back pain with right leg radiation. No joint swelling. PAST MEDICAL HISTORY: 1. Type 2 diabetes mellitus — diagnosed 2019 2. Essential hypertension — diagnosed 2018 3. Chronic lower back pain — diagnosed 2020 MEDICATIONS: Metformin 1000 mg BID Lisinopril 20 mg daily Atorvastatin 40 mg daily Ibuprofen 600 mg PRN for back pain ALLERGIES: NKDA EXAM: Vitals: BP 142/88, HR 78, BMI 31.2 General: Well-appearing, no acute distress Cardiovascular: RRR, no murmurs Pulmonary: CTAB Neurological: Alert and oriented x3. CN II-XII intact. Strength 5/5 in all extremities. Sensation intact. Negative straight leg raise. Musculoskeletal: Decreased lumbar ROM with flexion. Point tenderness over L4-L5. No erythema or warmth. ASSESSMENT & PLAN: 1. Type 2 diabetes mellitus (E11.9) — poorly controlled. A1c drawn today. Will consider adding GLP-1 agonist if A1c > 8.0. Reinforced dietary counseling and exercise. Reviewed glucose logs in detail (15 minutes spent counseling). 2. Essential hypertension (I10) — BP elevated today at 142/88. Will increase lisinopril to 30 mg daily and recheck in 2 weeks. 3. Chronic low back pain (M54.5) — acute exacerbation with right leg radiation. Will continue NSAIDs, add physical therapy referral. Discussed imaging if no improvement in 4 weeks. Reviewed MRI risks/benefits and alternatives (10 minutes). TIME SPENT: Total visit 42 minutes, of which approximately 35 minutes were spent in counseling and coordination of care reviewing glucose logs, medication adjustments, and treatment options for back pain. CPT BILLED: 99213
Current Code
Level 3 office visit — low complexity medical decision making, typically 30-39 minutes total time.
Potential Code
Level 4 office visit — moderate complexity medical decision making, typically 40-54 minutes total time.
Why Flagged
The documented encounter supports a Level 4 (99214) visit rather than the billed Level 3 (99213). Three stable chronic conditions were managed with medication adjustments (lisinopril increased), prolonged counseling (35 minutes), and moderate-complexity decision making regarding potential GLP-1 agonist therapy and imaging for back pain.
Supporting Evidence
Three chronic conditions managed with medication changes (metformin review, lisinopril increase, NSAID continuation)
35 minutes of counseling/coordination documented — exceeds the 40-54 minute typical time for 99214
Moderate-complexity MDM: multiple conditions with worsening control requiring prescription management and diagnostic imaging decision
Coding Basis
2021 E/M Office Visit Guidelines — time-based or medical decision making. 99214 requires moderate level of MDM or 40-54 minutes total time.
Coding Reasoning
The note documents 42 minutes total visit time with 35 minutes of counseling, and moderate MDM (multiple conditions, prescription management, risk of morbidity). Both time and MDM independently support 99214.
Why This Is Not Overcoding
This is not overcoding — the documentation explicitly supports a moderate level of medical decision making across three chronic conditions and exceeds the time threshold for 99214. The billed 99213 under-represents the documented complexity.
Current Code
Level 4 office visit (base code).
Potential Code
Prolonged service in the office setting requiring direct patient contact beyond the usual time — 30-74 minutes beyond the base code.
Why Flagged
The 35 minutes of documented counseling and care coordination exceeds the typical 99214 time and may support an add-on prolonged service code, depending on payer policy and whether the time was spent face-to-face.
Supporting Evidence
35 minutes of counseling/coordination documented beyond the typical 99214 time
Detailed review of glucose logs and treatment options for two conditions
Coding Basis
CPT 99354 — prolonged office service, 30-74 minutes beyond base code. Requires face-to-face time and payer coverage.
Coding Reasoning
The documented 35 minutes of counseling beyond the base visit may qualify for 99354, subject to payer-specific prolonged service policies and face-to-face documentation requirements.
Why This Is Not Overcoding
Only billable if the prolonged time was face-to-face and the payer recognizes 99354. Flagged as a medium-confidence opportunity for payer-specific verification.
EarnedMD findings are decision-support recommendations and do not constitute final coding or billing determinations. Billing decisions should be reviewed by qualified personnel and must be supported by the medical record and applicable payer requirements.