Introduction: Operating Room CPT coding accuracy is vital for accurate patient records, RVU productivity, billing, resident case logs, estimated operating room times, and hospital and provider accreditations. We identified a mismatch at military hospitals between what was scheduled via AORN codes versus what was surgically performed, documented, and billed for in CPT codes. We hypothesized that inaccurate coding led to incorrect patient records and missed RVUs and reimbursement and that implementing a process improvement (PI) project would improve these errors. Methods: Pre-intervention Nursing Intraoperative Reports and Surgeon Operative Reports were compared with the Coding Summary in 2023 from a Comprehensive Otolaryngologist at Naval Medical Center San Diego. A resident-led PDCA method PI project was implemented with the surgery schedulers, OR nurses, and surgeons. The new OR workflow included adding CPT codes to operative notes, having a laminated CPT quick reference for the OR nurse, and review of procedures completed as part of the Surgical Debrief. Six months after the PI project’s implementation, the intraoperative and operative reports with the coding summary were compared to assess the PI project’s impact in 2024. Results: Twenty-one pre-intervention cases and nineteen post-intervention cases were reviewed. For the pre-intervention cases, the Nursing Intraoperative Report matched the Operative Report in only 9.5% of cases. There was a discrepancy in what was billed versus what could have been billed in 57% of cases, with 129 RVUs worth of work not captured and over $13,000 of missed reimbursements. After the intervention, the Nursing Intraoperative Report matched the Operative Report in 58% of cases. Post-intervention analysis determined that the continued high level of discordance was mainly due to surgery cases being scheduled under AORN codes, which are similar but not equivalent to CPT codes, and the operating room nurses having to manually change the CPT codes intraoperatively. Conclusion: Prior to changing our OR workflow, more than half of Otolaryngology operative cases underestimated CPT coding correlating with 129 RVUs worth of work not captured and over $13,000 in missed reimbursement for just one Comprehensive Otolaryngologist over two months. Our workflow interventions decreased the discrepancy between the Operative Report and Coding Report. However, there remained a high discordance with the Intraoperative Nursing note, mostly due to cases being scheduled under similar but not equivalent CPT codes. Missed RVUs for work completed and under reimbursements due to inaccurate coding have significant financial and staffing implications.