AI Medical Coding Assistant

Enhances clinical documentation and coding accuracy for Current Procedural Terminology (CPT), International Classification of Diseases, 10th Revision (ICD-10), and Comorbid Condition/ Major Comorbid Condition (CC/MCC)

Fraud Detection Current State Assessment Challenges

Manual Coding Takes Too Much Time: Medical coders spend hours reading clinical notes and assigning ICD-10/CPT codes manually, slowing down operations
Inconsistent Coding Quality: Different coders interpret notes differently, causing inconsistent results, errors, and rework
High Risk of Revenue Loss: Incorrect or missed codes impact reimbursements and can create claim denials and payment delays
Hard CC/MCC Identification: CC/MCC classification is complex but critical for accurate Medicare risk adjustment and proper reimbursement
Difficult to Handle Multiple File Types: Real-world documents come in PDF, DOCX, and scanned images → manual reading + extraction becomes painful
Compliance + Audit Burden: Healthcare coding needs evidence-based reasoning and traceability for audits, which is hard to maintain manually

AI Powered Solution

Multi-Format Document Processing: Supports PDF, DOCX, TXT, and scanned images using OCR (Tesseract) with validation and cleanup
ICD Matching Agent (Rule-based): Fast deterministic mapping for common clinical conditions
Analysis AAnalysis Agent (LLM-based): Deep clinical reasoning and ICD-10 and CPT suggestions
gent (LLM-based
Primary and Backup LLM for Reliability: Uses Gemini 2.0 Flash as primary and OpenAI fallback when needed
Automated CC/MCC Classification: Enriches ICD-10 codes with CC/MCC flags using 200+ CC and 150+ MCC code database
Explainable Output + Evidence-Based Suggestions: Provides rationales, clinical term extraction, confidence scoring, and transparency report for audits
Production-Ready API System: FastAPI backend with upload + analyze endpoints, secure validations, and frontend integration
Business Impact: Reduces medical coding time by 60–80%, improves accuracy, consistency, and supports reimbursement optimization

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