ICD-10 & CPT Coding Assistant

A medical coding assistant that parses clinical notes and recommends appropriate ICD-10 diagnosis codes and CPT procedure codes with confidence scoring.

Overview

This skill analyzes clinical documentation to extract relevant medical information and map it to standardized coding systems:

• - ICD-10-CM: International Classification of Diseases, 10th Revision, Clinical Modification (diagnosis codes)
• CPT: Current Procedural Terminology (procedure/service codes)

Technical Difficulty: HIGH ⚠️

⚠️ HUMAN REVIEW REQUIRED: Medical coding directly impacts billing, reimbursement, and clinical documentation. All recommendations must be verified by a certified medical coder or healthcare provider.

Usage

CODEBLOCK0

Or use programmatically:

CODEBLOCK1

Parameters

Input Format

Accepts clinical notes in various formats:

• - Free-text narrative
• SOAP notes (Subjective, Objective, Assessment, Plan)
• Discharge summaries
• Progress notes
• Procedure reports

Output Format

ICD-10 Recommendations

CPT Recommendations

Confidence Scoring

• - 0.90-1.00: High confidence - Clear documentation, unambiguous mapping
• 0.70-0.89: Medium confidence - Good documentation, some interpretation required
• 0.50-0.69: Low confidence - Incomplete documentation, multiple possibilities
• <0.50: Very low confidence - Insufficient information, manual review essential

Limitations

1. 1. No Medical Advice: This tool does not provide clinical advice or diagnoses
2. Coding Complexity: Cannot handle all coding nuances (comorbidities, sequencing, modifiers)
3. Regional Variations: May not account for payer-specific coding requirements
4. Updates: Code sets may not reflect the latest annual updates

References

See references/ folder for:

• - icd10_common_codes.json: Frequently used ICD-10 codes by specialty
• INLINECODE10: Frequently used CPT codes by specialty
• INLINECODE11: General coding guidelines and conventions

Safety & Compliance

• - HIPAA Awareness: Ensure de-identification of PHI before processing
• Audit Trail: Maintain records of automated recommendations for compliance
• Human Oversight: All codes must be reviewed and approved by qualified personnel

Dependencies

• - Python 3.8+
• See requirements.txt for package dependencies

Risk Assessment

Security Checklist

• - [ ] No hardcoded credentials or API keys
• [ ] No unauthorized file system access (../)
• [ ] Output does not expose sensitive information
• [ ] Prompt injection protections in place
• [ ] Input file paths validated (no ../ traversal)
• [ ] Output directory restricted to workspace
• [ ] Script execution in sandboxed environment
• [ ] Error messages sanitized (no stack traces exposed)
• [ ] Dependencies audited

Prerequisites

CODEBLOCK4

Evaluation Criteria

Success Metrics

• - [ ] Successfully executes main functionality
• [ ] Output meets quality standards
• [ ] Handles edge cases gracefully
• [ ] Performance is acceptable

Test Cases

1. 1. Basic Functionality: Standard input → Expected output
2. Edge Case: Invalid input → Graceful error handling
3. Performance: Large dataset → Acceptable processing time

Lifecycle Status

• - Current Stage: Draft
• Next Review Date: 2026-03-06
• Known Issues: None
• Planned Improvements: