How it works

  1. Suggest candidate codes. MAIA reads the clinical note and returns ranked ICD-10/11, CPT, and HCPCS suggestions with confidence scores.
  2. Validate against CMS guidelines. A deterministic rules engine checks for Excludes1/2 conflicts, code-first ordering, use-additional pairs, specificity issues, and non-billable codes. Each potential problem becomes a review flag attached to the candidate.
  3. Coder approves, modifies, or rejects. The reviewer sees the suggestions ranked by confidence with all validator flags surfaced. Approve, modify, or reject per code; corrections feed back into MAIA's accuracy over time.

What gets coded

ICD-10-CM diagnoses
ICD-11 (where adopted)
CPT procedures
HCPCS Level II
E/M (CMS 2021 MDM)
Modifiers

Coverage focuses on primary care and the most common medical specialties. Surgical CPT coverage is being expanded specialty by specialty.

Frequently asked questions

How accurate is MAIA's ICD-10 coding?

Internal benchmarks against coder-validated charts show top-suggestion accuracy above 95% for primary diagnoses on common medical specialties. Every suggestion is reviewed by a credentialed coder or clinician before billing.

Does MAIA replace my coder?

No. MAIA is a suggestion-and-validation tool, not a billing autopilot. The pipeline is designed to make coders faster and more accurate, not to remove them from the loop.

Which CMS rules does the validator enforce?

The validator checks Excludes1 and Excludes2 conflicts, code-first ordering, use-additional companion codes, specificity (laterality, episode, encounter type), and non-billable/header-only code flags. Each potential issue is surfaced to the reviewer with a flag and the source guideline reference.

Does MAIA calculate E/M codes?

Yes. The E/M calculator implements the CMS 2021 office and outpatient rules deterministically. Inputs are number and complexity of problems, data reviewed, and risk; output is a recommended 99202 to 99215 code with the rule trace.

Related capabilities

Faster coding without losing the audit trail

Try MAIA's coding suggestions on your own charts. Limited early access is open to private practices in the United States.

Join the waitlist