Charge capture in medical billing: how charges go missing and the three checks that find them
The first version of this post was drafted in 2014, when a passenger jet had gone missing despite modern tracking systems. The biller who wrote it pointed out that charges can go missing too. Software has improved since then, and the point still holds. Charge capture in medical billing is the work of making sure every service that was documented becomes a charge, and every charge becomes a claim line. Software does most of that work now. Charges go missing at the hand-offs, and someone still has to check.
Finding a month-old treatment week that was never billed is frustrating. It is fixable, and the fix is a regular routine.
Where charges go missing
A denial appears on a remittance. A missing charge appears nowhere, so it helps to know where charges usually go missing.
| Problem | What it looks like | Typical cause |
|---|---|---|
| Visit with no charge | Patient marked arrived on the schedule, no encounter closed, no charge posted | Provider never finished the note, or the charge was keyed to the wrong date |
| Treatment delivered, management not billed | Daily delivery codes (77402, 77407, 77412) imported, but the weekly 77427 was never added | Fractions were not counted; the import brings delivery codes, not management |
| Drug units short | 96413 billed, the drug line shows fewer units than the dose in the record, or the discarded amount has no JW line | Units rounded down, or waste never recorded |
| Documented but never coded | Special treatment procedure (77470), weekly physics (77336) or an IGRT professional component in the chart, not on the charge | The coder worked from the charge sheet, not the record |
| Charge entered, then held | Charge sits in a scrubber hold or an unposted queue for weeks | The hold was never worked and no one tracked how long it had been held |
| Import failed with no warning | A day’s charges never arrived from the treatment system | Interface error with no alert; the queue looked normal because it was empty |
Each of these is caught by a different check, which is why one report is never enough.
Check one: reconcile the schedule, every day
The daily schedule is still the best charge capture tool a practice owns, because it is the one list of everyone who was supposed to be seen. The 2014 draft recommended exactly this, and it still applies.
- Pull yesterday’s appointments with a completed status (arrived, checked in, treated).
- For each, confirm a charge exists for the type of service scheduled. A consult should have an E/M; a treatment visit should have a delivery code; an infusion should have an administration code and a drug.
- Anything completed with no charge goes on a list to the responsible person that morning, not at month end.
- Confirm no-shows and cancellations are marked as such, so that every blank has a known reason. This helps auditors and your own staff later.
- Run the “checked in but not checked out” view. A patient who never checked out is either still in the building or has no charge.
MGMA’s July 2026 guidance for practices puts targets on this: clinicians close encounters within 72 hours and staff post charges within two days. Hold the schedule reconciliation to the same two-day window and a missing charge is two days old when you find it, not thirty.
Check two: count the fractions, every week
Radiation oncology has one charge that the treatment system cannot capture for you: 77427, radiation treatment management, five treatments. The delivery codes import from the record and verify system one fraction at a time. The management code is a count, and staff or a scrubber rule must do the count.
The rule is simple to state. One unit of 77427 for each five fractions delivered, on consecutive days or not. At the end of a course, three or four leftover fractions earn a final unit; one or two do not.
Worked example (illustrative). A prostate course is planned for 28 fractions of 77407.
| Fractions delivered | 77427 units earned |
|---|---|
| 1 to 5 | 1 |
| 6 to 10 | 2 |
| 11 to 15 | 3 |
| 16 to 20 | 4 |
| 21 to 25 | 5 |
| 26 to 28 (three remaining) | 6 |
If your billing shows five units of 77427 for this course, one week of physician management went unbilled. Across every course that ends mid-week, the total is significant. The weekly check is a report of delivery codes per patient since the last 77427; anyone at five or more, or at three or four with the course closed, needs a management charge. Iridium Suite’s scrubber does this count automatically and prompts for the 77427, as described in our earlier post on avoiding a 77427 audit.
Check drug units every week too. For a single-dose vial drug under Medicare Part B, the administered units bill on one line and any discarded amount bills on a second line with the JW modifier; when nothing is discarded, the JZ modifier attests to that. A chemotherapy line with the administered dose but no JW line for the rest of the vial is a short charge, and a line with neither modifier will be rejected.
Check three: read the record, every month
Once the charges exist, somebody should compare a sample against the documentation. The 2014 draft put this well: you may notice additional services that were provided but not reported. Pick ten charts a month across providers and service types and look for the documented-but-uncoded items in the table above. Also look the other way, for charges with no documentation, because a charge capture program that only looks for under-billing will miss over-billing that an auditor may find later.
What to do now
- Assign the daily schedule reconciliation to one named person, with a two-day standard for closing the gap.
- Build the weekly 77427 count as a saved report, or turn on a scrubber rule that does it.
- Add a drug-unit line check to the weekly review: administered units, JW or JZ, and the dose in the record.
- Set an alert on your charge interface so an empty import day triggers a warning.
- Sample ten charts a month against charges, in both directions.
- Iridium Suite’s Record and Verify integration imports patient demographics, insurance and CPT charges directly from the host record and verify system, which removes the hand keying between the treatment console and the claim.