This study determines the relative effect of financial incentives, practice characteristics, and regulatory guidelines on the utilization of documentation and coding technology among physician practices employing HIM professionals. A total of 442 HIM professionals, 9.78 percent of the surveyed population, completed a Web-based survey regarding their practices and E/M documentation and coding methods used. More physician practices use the traditional documentation and coding methods than use automated methods. Less than half of the practices using automated documentation technology also utilized automated coding technology. Financial incentives and regulatory guidelines were not related to documentation or coding method used. Organization size and type were highly related to documentation or coding method used. Practices using coding technology were more likely to perform coding validation. The reasons for low levels of coding technology adoption, which requires little additional physician effort, suggest the potential presence of unique factors inhibiting the adoption of this technology.