Encounter Coding Intelligence

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What you're looking at

The Encounter Coding Intelligence feature shows how you code your outpatient office visits compared to peers in your specialty and geography over the last 12 months. Two bars at the top of the tab show the mix of all coding systems used by yourself and your peers for office and outpatient visits. Hovering over or tapping a color on the scale displays the encounter rate for that code.

Below is a drop-down to filter by outpatient billing system, each leads to its own table. This is because different billing systems are coded differently and have different RVU values.

Both views show you:

• Encounters Analyzed: How many visits of that type you saw in the assessment window listed in the top right corner of the page.
• Complexity vs. Peers (For Office E&M/Consults): Whether your visits are typically simpler or more complex than peers (on a 1-4 scale). Other systems do not have complexity metrics, in this case the value will be null.
• RVUs vs. Peers: Estimates the RVU change if your coding mix matched peers', at your actual volume. This is not a per-visit average comparison. Large numbers on high-volume providers with a different mix are expected, not necessarily a problem.

Below that, a table breaks down the different codes in the billing system and how often you bill those codes compared to your peers.

This isn't about right or wrong coding. It's about showing you where your coding patterns differ from peers so you can see if there are legitimate opportunities to capture more RVUs.

How it’s calculated

See What You Need to Know About Medical Claims for additional background knowledge

Peer benchmarking: We compare your complexity and RVUs against an average of providers in your specialty and geographic location. See how we build your comparison group for more.

Complexity: Measured on a 1-4 scale from straightforward to high based on the MDM (Medical Decision Making) level associated with each procedure code. Your mean complexity is compared to your peer median (calculated from peer’s mean complexity).

• Note: 99211 (minimal complexity) has no MDM level and is excluded from the complexity average, but are still counted toward your total encounters analyzed.

RVUs (Relative Value Units): Work RVUs come from the CMS Physician Fee Schedule (PFS) Relative Value File, matched per code and per service year. For each code, we compare your % of visits at that code to peers' average % at that code (mean of each peer's own mix), then scale the gap by your visit volume and the code's work RVU. Summed across codes, this gives the RVU differential.

Data sources: Jiro uses office and outpatient professional claims across a 12 month rolling window ending with the latest month. We don’t include institutional or facility claims.

How to read this

Complexity differential: Your mean complexity minus your peer’s mean complexity. A positive number means your visits are usually more complex than peer’s while a negative number means your visits tend to be less complex. Neither is good or bad, your complexity reflects your patient panel and coding habits.

RVU differential: A positive number means you're billing higher RVUs per visit than peers. Context matters, this might mean you're coding at a higher level for comparable visits, or it might reflect your patient visits being higher complexity.

The code-level table: For the code system you've selected (New or Established), you see each level you bill (minimal, straightforward, low, moderate, high), how often you use it (your %), and how your specialty and geographic peers distribute across those same levels, followed by the national percentage.

Common questions

I don't see any data at all. What's going on?

This may happen for several reasons. The most likely reason is that your claims were not captured in Jiro’s database, so they aren’t shown on your dashboard. It’s also possible you don't have enough claims in the current 12-month window yet. Both resolve as more of your claims data comes in.

These peers don't look like my practice. Are you sure this is who you're comparing me to?

If the group feels off, check that your specialty is set correctly in your profile, that's what drives the match.

Why do New and Established have different numbers?

New patient visits are coded differently than established patient visits and carry different RVU values. A "Level 4" new patient visit is more work than a "Level 4" established visit so we benchmark them separately.

I code more complex visits than peers. Does that mean I should code less?

Not necessarily. If your patients genuinely are more complex, higher coding is appropriate. This data is directional context, not a directive. Your job is to code what the documentation supports, not to match your peers because you do not have the same patient panel.

I code simpler visits than peers. Am I leaving money on the table?

Possibly. If your visit complexity is similar to peers' but you're documenting less thoroughly, this could be a sign you are under coding. If your patients are genuinely less complex, that's just your panel. Sharing this data with your billing team or compliance officer can help you figure out which it is.

Should I code differently to match peers?

Code to the documentation and your patient's actual complexity. This feature is a comparison tool, not a coding guide. If you think you're under coding, work with your billing team or a coding consultant to review your documentation and your patterns. If you think you're over coding, talk to your compliance officer. Don't chase a number just because it's lower or higher than peers.

How current is this?

Encounter coding data is subject to claims lag, so this reflects claims that have had enough time to fully resolve, not what happened last week.

Limitations

• Claims data takes up to 6 months to arrive and be processed. Encounter Coding intelligence highlights the previous 12 months, so recent months may be incomplete.
• The MDM (1-4 scale we use) is one dimension of visit complexity. It doesn’t capture patient acuity, comorbidities, or the amount of time you spent during the visit. For example, two different Level-3 visits can be vastly different amounts of work.
• Peer comparisons don’t account for differences in patient complexity or your specialty’s case mix. A cardiologist seeing post-MI patients might have higher RVUs than a cardiologist in preventive care, even with identical coding patterns.
• Encounter coding intelligence covers office/outpatient E&M where you billed as the rendering provider. Only professional claims are used. Facility codes, tele-health adjustments, or claims where you're listed as consulting provider aren't included
• Claims are attributed to the NPI of the billing provider listed on claims. If you bill under someone else’s NPI (e.g. a resident under an attending) your claims will be attributed to that provider. Similarly, if someone in billing under your NPI, their claims will be attributed to you.
• We suppress samples smaller than 30 for a code system because numbers become volatile and are difficult to meaningfully benchmark.
• Minimal-complexity established visits (99211) have no MDM level, so they don't factor into your complexity average. They still count toward encounters analyzed.

Still need help?

Reach out to support using the help button in the app or by emailing support@jirohealth.com