Features

What it does

• Parses a clinical note (SOAP, op report, telehealth, multi-system follow-up) into a fully drafted outpatient claim.
• Picks CPT and ICD-10 codes, suggests modifiers, computes per-criterion confidence on every modifier rubric.
• Cross-checks NCCI PTP edits, MUE limits, age/sex restrictions, and LCD/NCD coverage at your locality.
• Surfaces clinician-facing drafter language for every WEAK or FAIL — the exact phrasing to add to the chart to support the line.
• Produces three export formats: printable claim sheet, CSV, and JSON.

How to use it

1. 1.Open AI Coder. Navigate to /ai/notes/new from the dashboard or the top nav.
2. 2.Paste your note. SOAP, op report, telehealth — any free-text clinical documentation up to 15,000 characters.
3. 3.Pick a specialty (optional). Auto-detect runs by default; override via the Specialty dropdown to weight rubrics for your specialty.
4. 4.Click Draft claim →. Streaming pipeline: PARSE (extract codes) → VERIFY (NCCI · MUE · age/sex) → ENRICH (Coverage · drafter language) → DONE. ~6s to first card.
5. 5.Review per-procedure cards. Each card shows code + modifier + confidence + fee, evidence chips quoted from your note, NCCI verdicts, modifier rubric evaluation, and LCD/NCD coverage badges.
6. 6.Reject lines you don't want. Per-line and per-modifier Reject buttons remove the suggestion. Click '+ Add code' to manually append.
7. 7.Export. Copy text, Copy CSV, Printable, or 'Scrub before submit' to hand off to Claim Scrub for a final pass.

What you get back

When to use it

When you've received a clinical note and need a fully drafted claim with the modifier and coverage decisions already made — defensibly, in seconds.

Related terms

PASS, WEAK, FAIL, NCCI PTP edit, Modifier rubric, E/M MDM, LCD, Article (LCD/NCD), Locality, Confidence score, Trace ID

Pairs well with

Claim Scrub, Modifier Advisor, NCCI Edit Validator

What it does

• Validates a finished claim before submission against six rule sets: NCCI PTP edits, MUE limits, ICD-10 Excludes1, age/sex restrictions, modifier validity, and LCD/NCD coverage.
• Returns PASS/WEAK/FAIL per procedure line and per diagnosis with an AI-drafted recommendation per finding.
• Two input modes: paste a free-form claim string, or fill the structured form (procedures, modifiers, diagnoses, patient sex+age, DOS, locality).
• Same lifecycle pipeline as AI Coder (PARSE → VERIFY → ENRICH → DONE).

How to use it

1. 1.Open Claim Scrub. /tools/claim-scrub or 'Scrub before submit' from an AI Coder draft.
2. 2.Paste or fill. Paste mode accepts strings like 99214-25, 93000 · I10, E11.9 · 58F · DOS 2026-05-07 · NJ. Structured mode breaks the same data into form fields.
3. 3.Click Scrub claim →. Lifecycle: PARSE (validate shape) → VERIFY (Excludes1 · age/sex) → ENRICH (LCD/NCD · language) → DONE. ~5s.
4. 4.Review verdicts. PASS lines are clean. WEAK lines need documentation review (the AI explains what's missing). FAIL lines should not be submitted as-is.
5. 5.Export. CSV or PRINT for the audit folder.

What you get back

When to use it

After you've drafted (or imported) a complete claim and want a final compliance pass before billing.

Related terms

PASS, WEAK, FAIL, NCCI PTP edit, MUE, Excludes1, LCD, NCD, Locality, Trace ID

Pairs well with

AI Coder, NCCI Edit Validator

What it does

• Targeted modifier decision support: tell it the procedure and a sentence of clinical context, it tells you whether the modifier is appropriate.
• Scores every criterion in the matching rubric (Mod 25 has 4, Mod 59 has 4, etc.) with confidence percentages.
• Lists exactly what's missing from the documentation — 'doc-gap list' — so you know what to add to the chart.
• Bridges to NCCI: if the procedure pair has a PTP edit, the advisor names the override modifier and walks the rubric.

How to use it

1. 1.Open Modifier Advisor. /tools/modifier-advisor or click 'Validate this modifier choice with AI →' from the NCCI Validator's WEAK conflict cards.
2. 2.Enter the procedure. CPT or HCPCS code.
3. 3.Add clinical context. One or two sentences from the chart describing what was done.
4. 4.Optionally add diagnoses. Multi-select ICD-10s if relevant to the modifier choice.
5. 5.Click Get recommendation ⌘+↵. AI returns per-criterion verdicts, doc-gap list, and the recommended action (append / don't append / append with documentation).

What you get back

When to use it

When you're not sure whether to append a modifier, want a documented audit trail of the decision, or want to see what's missing from the chart before you bill.

Related terms

PASS, WEAK, FAIL, Modifier rubric, NCCI PTP edit, Modifier indicator, Confidence score

Pairs well with

AI Coder, NCCI Edit Validator

What it does

• Indexes 3.1M+ NCCI PTP edits across both Practitioner and Hospital Outpatient settings.
• Pair-checks every combination of the codes you enter; surfaces FAIL (no override) and WEAK (override available) verdicts with the matching modifier rubric inline.
• Returns the MUE limit + MAI category for each input code in a separate table.
• Bridges to Modifier Advisor for the canonical override modifier (Mod 25 if E/M+procedure, else Mod 59).

How to use it

1. 1.Open NCCI Validator. /tools/ncci.
2. 2.Enter 2–25 codes. Comma-, space-, or newline-separated.
3. 3.Pick the setting. Practitioner (office/clinic billing) or Hospital (outpatient department billing).
4. 4.Click Validate Codes. Conflict cards appear for every WEAK or FAIL pair; MUE table renders below.
5. 5.Drill into a WEAK. The matching modifier rubric (Mod 25 or 59) renders inline with all criteria. 'Validate this modifier choice with AI →' bridges to Modifier Advisor.

What you get back

When to use it

When you have a draft code list and want to spot bundling conflicts and unit-cap issues before drafting the rest of the claim.

Related terms

PASS, WEAK, FAIL, NCCI PTP edit, Modifier indicator, MUE, MAI, Modifier rubric

Pairs well with

Claim Scrub, Modifier Advisor

What it does

• Two modes: Medical Decision Making (2-of-3 rule across Problems / Data / Risk) or Time-Based.
• Supports established and new patient codes (99202–99205, 99212–99215).
• Renders the official 2021+ AMA criteria for each MDM element so you can score against the chart.
• Returns the recommended CPT code with the level reasoning.

How to use it

1. 1.Open E/M Calculator. /tools/em-calculator.
2. 2.Pick mode. Medical Decision Making (default) or Time-Based.
3. 3.Pick patient type. Established Patient or New Patient.
4. 4.Score each element (MDM mode). Problems Addressed → Straightforward / Low / Moderate / High. Data Reviewed & Analyzed → same. Risk of Complications → same.
5. 5.Click Calculate E/M Level. Returns the level reached by 2 of the 3 elements (e.g., Low Low Low → 99213).

What you get back

When to use it

When you're uncertain which E/M level the chart supports and want a structured 2021+ AMA scoring walkthrough.

Related terms

E/M MDM

Pairs well with

AI Coder

What it does

• Indexes every active LCD nationwide and every NCD.
• Three search modes: by Keyword (free text), by Code (CPT/HCPCS), by LCD/NCD ID.
• State filter pins results to a specific MAC jurisdiction.
• Returns the policy with covered diagnoses, frequency limits, and the companion Article (when present).

How to use it

1. 1.Open LCD Coverage Search. /tools/lcd.
2. 2.Pick search mode. Keyword / Code / LCD ID.
3. 3.Optionally filter by state. All states (default) or a specific MAC jurisdiction.
4. 4.Pick scope. All / LCD / NCD.
5. 5.Run search. Result list links each policy to its full text and companion Article.

What you get back

When to use it

When you need to confirm whether Medicare covers a procedure for a given diagnosis in a given jurisdiction.

Related terms

LCD, NCD, Article (LCD/NCD), Locality

Pairs well with

AI Coder, Claim Scrub

What it does

• Returns the global-period code (000 / 010 / 090) for any surgical CPT.
• Computes the exact pre-op, day-of, and post-op date ranges from your surgery date.
• Tells you which related E/M visits are included (and which need modifier 24 or 79).

How to use it

1. 1.Open Global Days Calculator. /tools/global-days.
2. 2.Enter the CPT code. Common surgical examples: 27447, 29881, 47562, 43239, 66984.
3. 3.Enter the surgery date. Date of service of the procedure.
4. 4.Click Calculate. Returns global-period type + the three date windows.

What you get back

When to use it

Before billing an E/M during a postop period — to know whether you need modifier 24 (unrelated E/M) or 79 (unrelated procedure).

Related terms

Global period (000 / 010 / 090)

Pairs well with

AI Coder

What it does

• Browses the ICD-10-CM Official Guidelines for Coding and Reporting (Conventions, Selection of Principal Diagnosis, Reporting Additional Diagnoses, Outpatient Services, Present on Admission).
• Surfaces NCCI coding policies for CPT/HCPCS bundling.
• Indexes ICD-10-PCS conventions and Tabular Notes (Includes/Excludes1/Excludes2/Code first/Use additional code).
• Deep-linked from code-detail pages so you can jump from a specific code to the governing guideline.

How to use it

1. 1.Open the Guidelines reference. /tools/guidelines, or click 'Coding Guidelines' from any code-detail page.
2. 2.Pick a code set. Tabs at the top: ICD-10-CM, ICD-10-PCS, CPT/HCPCS, Tabular Notes.
3. 3.Pick a section. The sidebar lists chapters and subsections. Selecting a section renders the full guideline text inline.
4. 4.Search within a section. Use the browser's Find (Cmd+F) to locate specific phrases or coding conventions.

What you get back

When to use it

When a coding question hinges on official guidance — e.g., principal diagnosis selection, reporting additional diagnoses, outpatient-service rules, NCCI coding policy, or instructional notes (Includes / Excludes1 / Excludes2 / Code first / Use additional code).

Related terms

Excludes1

Pairs well with

AI Coder