[Beta] AI-Recommended CPT Codes

Feature Overview

This is an AI-powered feature that analyzes your clinical note to recommend accurate medical billing codes using both time-based and medical decision-making approaches. The system captures relevant factors from clinical notes, prompts physicians for additional information, and recommends the most accurate billing code for review, thereby increasing revenue for healthcare providers.

Why We Built This/Primary Use Cases:

Accurate medical coding and billing are essential to ensure that clinicians receive proper reimbursement. Yet, this process is often time-consuming and prone to errors; the American Medical Association (AMA) reports that coding inaccuracies cost the healthcare industry an estimated $36 billion annually in lost revenue, denied claims, and penalties.

Empathia’s AI-driven Billing Code Recommendation System is designed to streamline this process, reducing time demands and minimizing errors for a more efficient, reliable workflow.

How-To Guide

1. Open the clinical note you would like to generate the billing code for and click on the Smart Edit button to launch the chat box
   
2. Select the option to “Generate Billing Code by Time” or “Generate Billing Code by MDM”
   
3. Answer the follow up prompts to get the recommended billing code

    4. Once all the responses are provided, a CPT® billing code will be recommended along with an explanation of why             the code was selected.

    5. You can copy the billing code along with the rationale into your note. This makes the coding process "interpretable" and can speed up the billing process for you or your medical coder.  

Best Practices and Tips

1. Ensure to answer each of the follow up questions to get the most accurate recommendation.

FAQs -

1. How is the billing code generated? 

EMMA collects data from your encounter to assess the number and complexity of the issues addressed, asks         questions to determine the time spent and tasks performed outside of the encounter, and then generates a response using predictive analysis along with a CPT coding decision tree.

2. Can this tool be used to recommend codes for existing notes from my EMR?

This feature is currently capable of recommending a billing code for encounters within Empathia only.