Dr. OHANISIAN

Spent 5 minutes today watching an AI read a routine ortho note and find $390 in unbilled codes. G2211 visit complexity, ultrasound-guided injection upcode, CCM minutes from PT coordination. The codes existed. The documentation existed. We just weren't trained to capture them.

If you're an orthopedic surgeon and you can't articulate exactly what G2211 is, you're leaving $5K-15K/year on the table per surgeon. It's a 2-minute rule and a 30-second documentation habit. Modern ortho billing isn't taught — it's discovered.

I watched something this week that made me reconsider how we train orthopedic surgeons on revenue. A tool reads a clinical note — one I wrote, with all the messy real-world detail of a routine knee OA follow-up — and within seconds returns the codes I documented but didn't bill. G2211 for visit complexity. CCM 99491 for the 18 minutes of care coordination time. An ultrasound-guidance upcode I'd have left as a standard injection. The dollar value on a single visit isn't life-changing. ~$390. But across a panel of 600 patients with chronic OA being managed longitudinally? It's $180,000-$240,000 per surgeon per year sitting in plain sight. The bottleneck isn't documentation. It isn't billing software. It's training. Most of us learned ortho coding (if at all) before G2211 existed, before RTM existed, before TCM was a meaningful revenue line. We're still billing like it's 2015. The interesting question isn't "how do I get my biller to catch this" — they don't have time and they don't have your context. The interesting question is: what does it look like when the AI is in the loop with the surgeon at the moment of documentation? That's the question I'm spending the next year on.