- 01
The provider signs the note.
Providers document and sign in your EHR exactly as they do now: no new screens, no templates to change. The signed note is where coding starts.
- 02
Every code comes with its documentation.
Diagnoses, services, the E/M level, modifiers and units are coded together. Each line points to the words in the note that support it, and the level shows its problems, data and risk.
- 03
The claim is checked before it leaves.
Code pairs, unit limits, frequency limits, diagnosis pointers and place of service are checked on every encounter. Anything that needs judgment goes to your coders with the reason.
- 04
The codes land on the claim.
Codes, units, modifiers and diagnosis pointers are written back to the encounter in your EHR, ready for your billing team to submit. Nobody re-keys a code.
FreeE/M level calculator: paste a note, get the level
Every code, tied to the note.
AI medical coding for outpatient practices and billing teams. Medicodex codes each encounter as the provider signs it, and shows the documentation behind every line of the claim.
Progress note
- CC
- Sore throat and fever for two days.
- HPI
- 34-year-old established patient with painful swallowing and subjective fever. No cough.
- Exam
- T 101.2 °F. Tonsillar exudate; tender anterior cervical nodes.
- Tests
- Rapid strep antigen performed in office: positive.
- Assessment
- Streptococcal pharyngitis.
- Plan
- Fluids and rest; return if not improving in 48 hours. Amoxicillin 500 mg twice daily for 10 days.
Ready to bill · 3 codes, each tied to the note
The numbers behind every claim.
- Encounters coded
- 10,000+
- Encounters coded with no line held for review
- 96%
- CPT®, HCPCS and quality codes captured per 100 encounters
- 654
- Quality codes reported per 100 encounters
- 302
- Screening codes captured per 100 encounters
- 96
- In-office test codes captured per 100 encounters
- 33
*Rates calculated from encounters coded on Medicodex.
Less waiting on coding. Fewer claims coming back.
What changes for a practice or a billing team when every signed encounter is coded the same careful way.
A shorter coding backlog
Encounters are coded every day as notes are signed, so charts stop waiting in a queue for a coder and claims go out sooner.
Scrubbed before it is submitted
Every claim is scrubbed for code-pair edits, medically unlikely units, frequency limits and diagnosis pointers before release, not after a denial comes back.
Charge capture you can defend
In-office tests, counseling time, screenings and quality codes are billed when the note documents them, and only then.
E/M levels you can explain
Every visit shows the problems addressed, the data reviewed and the risk of management, plus the time-based level when total time is documented.
Provider-wise CPT analysis
See each provider's code mix and E/M level distribution beside what their notes document, so coaching starts from facts, not hunches.
Payer rules and expected payment
Each payer's coding rules are applied to the claim, and every claim shows the amount it should pay, priced from what that payer actually allows.
From signed note to clean claim.
The same four steps for every encounter.
Medicodex Insights
Every coded encounter feeds a dashboard for your practice or billing team: the charges you are capturing, what each payer pays for each code, and how each provider codes.
- Charge capture forecasting
- Payer-wise payment comparison
- Provider-wise CPT analysis
- Claim scrubbing results
- Documentation insights
- Audit trail
What gets coded.
The whole professional claim for an outpatient visit, not just the E/M line.
CPT® codes shown as numbers only. CPT is a registered trademark of the American Medical Association.
Office visits
99202–9920599212–9921599417G2212
New and established, leveled on MDM or total time; prolonged time by payer
Preventive visits
99381–99397
By age band, with separately documented problem visits
In-office tests
8788087804 ×2874268102581002
With the right units, and only when the test was done in the office
Counseling
99401–9940499406–99407
By documented minutes, never for counseling on the problem already treated
Screenings
9612796160G0444G0442H0049
By instrument, age and payer, within annual limits
Quality codes
1036F1159F3008F
CPT® Category II from what the visit documents: tobacco, medication review, BMI, blood pressure
Modifiers
2559QW95LT / RT / 50
Only where the documentation and the payer call for them
Diagnoses
ICD-10-CM
Primary first, reason-for-visit Z codes, external cause never first, up to four pointers a line
A claim your coders can check in seconds.
Each line carries the documentation that supports it, so a coder confirms instead of re-reading the chart, and a payer question has an answer on file.
- Primary diagnosis first, pointed to the right lines
- E/M level from problems, data and risk, with the time-based level when total time is documented
- Modifiers only where the documentation supports them
Encounter · Urgent careEstablished patient · Synthetic
Ready to bill| Line | Code | Units | Dx | Documentation |
|---|---|---|---|---|
| 1 | 99213 | 1 | A | Acute illness treated with a prescription: “Amoxicillin 500 mg twice daily for 10 days.” |
| 2 | 87880 | 1 | A | “Rapid strep antigen performed in office: positive.” |
A · J02.0 Streptococcal pharyngitis · primary · “Streptococcal pharyngitis.”
Coding that holds up in an audit.
The level follows the documentation. When the documentation and the level the provider picked disagree, in either direction, a person decides.
- Every code is supported by the provider's documentation.
- E/M levels follow the AMA medical decision making guidelines: two of three elements.
- Nothing is raised to increase payment. Doubtful levels are held, not billed.
- Documentation support is kept with every encounter, ready for audits and appeals.
How this visit's level was set Synthetic
ProblemsAcute, uncomplicated illness
DataOne test ordered
RiskPrescription drug management
StraightforwardLowModerateHigh
Two of three elements meet Low99213 established · 99203 new
Works inside your EHR.
Signed encounters are read from your EHR and the codes are written back to the claim. Exceptions sit in a queue your team works from. Providers keep documenting the way they do today.
- Weeks 1–2ConnectEHR access, payers, fee schedules and your coding preferences.
- Weeks 3–5ValidateWe code a sample of your past encounters; your coders review every line with us.
- Weeks 6–8Go liveOne service line first, then the rest, with results shared weekly.
- Target onboarding 30–60 days, depending on EHR access.
Questions buyers ask first
What is AI medical coding?
AI medical coding software reads the provider's documentation for an encounter and assigns the codes a claim needs: CPT® and HCPCS codes for the services, ICD-10-CM codes for the diagnoses, the E/M level for the visit, and the modifiers, units and diagnosis pointers that tie them together. Done well, it codes routine encounters in minutes and sends the ones that need judgment to a certified coder.
Does it replace our coders?
No. It takes the routine, high-volume encounters off their desk so they can focus on the charts that need expertise: documentation questions, unusual services, payer disputes. You decide which encounters always go to a person.
Will it upcode to increase revenue?
Never. Every code must be supported by the provider's documentation. If the documented level and the level the provider selected disagree, in either direction, the encounter goes to a coder instead of being changed automatically. Compliant revenue is the only revenue worth capturing.
How long does onboarding take?
Our target is 30 to 60 days from signed agreement to go-live: EHR connection, payer and fee schedule setup, validation on your past charts, then go-live one service line at a time. Timing depends mostly on how quickly EHR access is granted.
Is your platform HIPAA compliant?
We operate as your business associate under HIPAA and sign a Business Associate Agreement before we receive any protected health information. We access only the minimum necessary data to code your encounters. See our security page for details.
How much does AI medical coding cost?
Pricing depends on your monthly encounter volume, your specialties and your EHR. Request pricing and we'll send it within one business day.
See how your encounters would be coded.
A 30-minute walkthrough, then a validation plan on your own charts: what we connect, how we measure, and what it costs.