Noise or signal: Achieving better communication and understanding between physicians and coders

Clear communication between clinicians, administrators, and coders is vital for maintaining compliance and revenue integrity and for safeguarding patient care quality.

In their 2025 MGMA Summit presentation, “Noise of Signal: Decoding Messages from Physicians and Coders,” industry experts Pam D’Apuzzo, CPC, ACS-EM, ACS-MS, CPMA, managing director of VMG Health, and Betsy Nicoletti, MS, CPC, founder of CodingIntel, shed light on common pitfalls, effective practices, and emerging complexities in medical coding.

As Nicoletti said, these issues are like a vehicle’s check engine light — news you don’t want to receive but absolutely can’t ignore when it comes to revenue integrity. For D’Apuzzo, addressing the friction between physicians, advanced practice providers (APPs), and coders is about understanding what coders are looking for when they work.

“I think [some practices] fail to really give [physicians and APPs] the information that they need to understand what [coders are] looking for from a documentation support standpoint,” D’Apuzzo said, noting that coders are often looking for more detail to support an E/M. “If you look at even the very onset of the documentation, that first field of reason for visit or chief complaint, and it says, ‘patient here without complaints’ or ‘patient here for follow-up,’ these are not sufficient reasons for a visit.”

Medical necessity

Medical necessity is the foundation of appropriate coding. Nicoletti recounted a case involving medical necessity denial for a bone density scan because of improper diagnosis coding — an error that went undetected for months. Examples like this highlight the need for revenue cycle teams to actively monitor claim denial reasons and maintain consistent oversight.