Using MAIstro for Medical Coding
Data Harmony Users Group Meeting
February 7, 2017
An Extremely Brief History
• Access Integrity (AI2) founded in 2011 by Margie
Hlava, Jay Ven Eman, and John Kuranz.
• Of the six markets in the medical space that were
considered, the provider market was deemed the
most lucrative for this technology.
• Multiple Electronic Health Record (EHR)
integrations including athenahealth and
How It Works
• Leverages Data Harmony in the medical space to
deliver relevant ICD-10, CPT, and HCPCS code
• The massive rule bases (4.6 million lines for
ICD-10) analyze the content and context of the
providers’ notes in an EHR.
• Delivers highly relevant diagnosis and procedure
coding suggestions, while supplying revenue
cycle and denial management resources.
So What’s the Problem?
• Providers are required by clinic management to
provide ICD-10 codes for an encounter. Doesn’t
the clinic hire coders to do this?
• Providers are out of their element and miss
codes that can pay them more. MAIstro captures
and recommends these.
• Doctors want to be doctors, but they have to take
time with unfamiliar code sets and concepts,
keeping them from providing you the care they
know they should deliver.
AI2 Integration Basic: Medical Claims Compliance (MCC)
Upload a file or paste text for
Codes are suggested based on
Selected codes are separated from
suggestions for copying and
pasting into an EHR.
Search functionality for code and
AI2 Integration Intermediate: Find-A-Code (FAC)
Everything in MCC also exists in Find-A-
Code, with some additions.
Zip code is required to calculate Relative
Value Units (RVUs), which determine
how much a practice gets paid. Health
care is cheaper in Cheyenne than
Book View surfaces the hierarchy,
allowing users to see the codes
surrounding the suggested codes.
Scrub functionality checks selections
against medical databases and returns
errors if they exist. This is not a well-
AI2 Integration Advanced: IntegraCoder (IC)
IntegraCoder validates the codes
selected within the EHR.
View and select modifiers for
more accurate reimbursement.
Search individual code sets or
search globally. Feedback button
allows for easy
selections back into
the EHR billing
• ICD-9 was adopted as a standard in 1979.
• ICD-10 completed in 1992 and adopted by most
of the world by 2010, rendering ICD-9 obsolete.
• Implementation stalled over and over in the
United States until 2015, when a reprieve was
filed with Congress on hiatus, preventing a vote.
• Much to clinics’ dismay, ICD-10 would be
implemented on October 1, 2015.
Dr. Manley looks peaceful, but
what’s in his dreams?
The labyrinthine hellscape of
The next morning, people still got
sick and doctors still had to doctor.
That’s when the real monster under
the bed emerged.
Mama! A turtle
bit me right on
W59.21XA – Bitten by turtle, initial encounter
Y92.830 – Public park as the place of occurrence of the external cause
F40.248 – Other situational type phobia
OH THE HORROR!
What Is E&M?
• A tiny division of the CPT code set that
determines the level of service during an
• E&M determines how much time a provider
spent with a patient, the thoroughness of the
examination, and the level of associated risk.
Why is E&M Important?
• It determines how much a provider gets paid for
a particular encounter.
• Overcoding E&M can trigger audits, which can
potentially bankrupt a practice.
• As a result, practices undercode E&M, causing
lower reimbursement while still putting practices
at increased risk.
• Practices report an accuracy rate of only 30% for
The Data Harmony Solution: eMDoc
• Uses five thesauri to differentiate between the
various places where E&M is calculated.
• Pulls information from patient history,
examination, and risk/decision-making areas of
• If it’s not in the documentation, it didn’t happen,
no matter what actually occurred during an
encounter. DOCUMENT WHAT YOU DID!
• Should we actually look at it?...yes we should.
eMDoc: A Closer Look
The final E&M calculation (CPT code) is
presented at the top, along with the
time spent with the patient and the
calculations of each individual section.
Green text indicates what was checked
in the examination.
Clicking the “?” will highlight where in
the note that piece occurs, giving
providers at-the-ready documentation
for why an encounter was coded to a
This fact is CRUCIAL for combatting
Where Is AI2 Headed?
• E&M revealed other places for Data Harmony:
• HCC (Hierarchical Condition Coding): 79
specific IDC-10 codes that determine level of
• NCCI (National Correct Coding Initiative): A
grouping of CPT and HCPCS codes that reflect
connections between procedures and their
ICR-10 diagnosis counterparts.
• RAF (Risk Adjustment Factor): A sliding scale
to determine an individual’s level of “risk”
compared to their age and status.
– Other situational type phobia
• I hope I didn’t trigger
this for you.
G47.419 – Narcolepsy without cataplexy
For further questions, contact me at
firstname.lastname@example.org or visit us at
www.accessintegrity.com. Thank you!