Medical Coding
Transform clinical docs into compliant ICD-10, CPT, and HCPCS codes with audit-risk flagging.
What You Can Do
This skill analyzes clinical narratives and procedure notes to generate ICD-10 diagnosis codes with proper specificity, recommend CPT codes with bundling considerations, and identify applicable HCPCS Level II codes. It flags upcoding risks, documentation deficiencies, sequencing errors, and medical necessity misalignments—functioning as a secondary quality-control layer in your revenue cycle before claims leave your organization.
Features
ensures codes match documentation precision
prevents incorrect code combinations and payment denials
captures supplies, DME, and injections often missed in standard coding
flags codes unsupported by clinical evidence before submission
identifies missing details that expose claims to audit or denial
ensures correct diagnosis hierarchy and medical necessity alignment
highlights high-risk patterns that trigger compliance reviews
provides actionable notes for coder correction or documentation requests
Example Output
Input: Operative note describing right shoulder rotator cuff repair with subacromial decompression for impingement syndrome.
Output:
- Primary Diagnosis: M75.41 (Impingement syndrome of right shoulder) ✓ Supported by doc
- Secondary Diagnosis: M75.121 (Rotator cuff tear, right shoulder, not specified as traumatic) ⚠️ Flag: Repair vs. tear terminology — verify if true tear documented
- Primary Procedure: 23410 (Repair rotator cuff [open], massive tear) ⚠️ Alert: "Massive" tear not explicitly stated — consider 23412 (other than massive) if documentation unclear
- Secondary Procedure: 23405 (Subacromial decompression) ⚠️ Bundling note: Verify payer policy — some plans bundle this with rotator cuff repair
- Audit Risk: Medium — Massive tear designation without size/extent documentation could trigger medical necessity review
Input: Office visit note for diabetes management and hypertension follow-up with new metformin prescription.
Output:
- Primary Diagnosis: E11.9 (Type 2 diabetes without complications) ✓ Documented
- Secondary Diagnosis: I10 (Essential hypertension) ✓ Documented
- Gap Alert: HbA1c or glucose value not documented — recommend adding to support E&M complexity level
- Compliance Note: No medication allergies or contraindication review noted for metformin — consider adding for liability documentation
What's Included
- SKILL.md instruction file: complete coding protocol and compliance workflow
- ICD-10/CPT/HCPCS code reference matrix: quick-lookup template for common diagnoses and procedures
- Documentation gap checklist: items to verify before submitting claim
- Audit risk scoring framework: flags high-risk code combinations and missing elements
- Compliance verification checklist: ensures medical necessity and sequencing alignment
Who It's For
- Medical billing managers — validate coder output before claim submission and reduce denial rates
- Certified coding specialists — secondary review tool for complex cases or unfamiliar procedure types
- Practice compliance officers — pre-audit claims and identify systemic documentation deficiencies
- Healthcare providers self-coding — low-complexity office visits and minor procedures with confidence
- Revenue cycle training coordinators — teach coding accuracy and compliance standards to new staff
Best For
- Pre-claim quality audits — review coded encounters 24-48 hours before submission
- Upcoding and compliance risk detection — flag unsupported code assignments before payer review
- Documentation gap identification — pinpoint missing clinical details that weaken medical necessity
- Coder training and verification — validate new staff accuracy and explain coding rationale
- Unfamiliar condition/procedure coding — secondary reference for rare diagnoses or complex surgical cases
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