Overview
What is AI Coding?
When triggered, AI Coding automatically adds the following types of codes to the Billing Section of your visit note based on the information listed:- CPT Codes - Evaluation & Management CPT codes are auto-populated based information included in the patient’s chart.
- Diagnosis Codes - Suggests and populates supporting ICD‑10 diagnosis codes per CPT line based on the visit note snapshot and the patient’s problem list.
- NDC Codes - Identifies drug codes and auto-populates NDC code, dosage, measure, and units using the patient’s chart and historical claims.
- Lab & Vaccination Codes - Reads recent lab measurements (including point-of-care labs) and documented vaccinations from the patient’s chart and uses them as context when generating codes, which can result in the corresponding lab or vaccination codes. For example, an A1c result captured from point-of-care labs can be used to code the corresponding measure.
- Modifiers - AI Coding can add modifier 25 when the visit note documents a significant, separately identifiable Evaluation & Management (E/M) service alongside a procedure on the same day, and modifier 59 when the documentation supports billing a procedure as a distinct service.
- Place of Service & Modifiers (Telehealth) - For telehealth visits, AI Coding automatically applies the correct Place of Service (POS) and telehealth modifier. It adds modifier 95 to the Evaluation & Management (E/M) line and sets POS 10 (telehealth in the patient’s home) for Medicare, or POS 02 for commercial payers. Modifier 95 is added only to the E/M line (not to wellness, Annual Wellness Visit, or preventive lines), and it is not applied to audio-only (telephone) visits, since modifier 95 is for audiovisual telehealth.
What are the benefits of AI Coding?
AI Coding expedites coding and improves coding accuracy and completeness.Automated quality coding (MIPS)
When enabled, Quality Coding lets AI Coding automatically add QPP (MIPS) quality measure codes to bills during coding automation. This helps your practice meet the CMS reporting minimum of at least six quality measures, reducing the risk of MIPS penalties. Quality Coding identifies measures only when they are clearly documented in the visit note. AI Coding currently supports the following quality measures:- Diabetes care - blood sugar control (such as A1C results) and diabetic eye/retina evaluations.
- Depression screening - a documented screening and any follow-up plan when one is indicated.
- Blood pressure control - blood pressure values recorded during the visit.
- Weight / BMI - a documented BMI and, when required, a related follow-up plan.
- Advance care planning - a documented discussion or recorded plan.
- Falls risk - a fall-risk assessment and documented plan of care when applicable.
- Tobacco use - tobacco-use screening and any documented cessation counseling or support.
Setup
AI Coding must be enabled by an Admin Level User by following these steps:Enabling Quality Coding (MIPS)
Quality Coding (MIPS quality measures) is enabled separately from the main Billing Analysis toggle. An Admin Level User can turn it on by following these steps:
By default, Quality Coding applies to Medicare payers and Annual Wellness Visits (AWVs).
Workflow Instructions
Using AI Coding
To use AI Coding:Reverting automatically generated codes
To revert the bill to what it was before using AI Coding, click the Revert to previous bill button at the top of the codes section.Providing feedback about the automatically generated codes
Click one of the feedback buttons to provide Elation feedback about AI Coding. This will assist Elation with improving on the tool.- Mark as helpful
- Mark as unhelpful
Reviewing AI Coding citations and providing feedback
Each AI-suggested CPT line, diagnosis (DX) row, and modifier displays an information (i) icon when supporting evidence is available. Click it to open the citation dialog, which shows:- a plain-language rationale explaining why the code was suggested;
- the suggested code and its standard description;
- an inline preview of the visit note with the exact supporting text highlighted.