Health

MD Review and Coding Agent

Coding happens at discharge, the review months later. Revenue hinges on a secondary diagnosis.

Improves first-pass coding, the one lever that scales before review rates tighten.

Open agent
Public administration

Four processes that take up the most time today

Developed in Germany · Hosted in the EU

Developed in Germany · Hosted in the EU or on-premises

Delivered together with

STACKIT Sovereign hosting in Germany, single-tenant from the first user.
Rödl Legal, tax and compliance expertise for legally sound deployment.
4P Consulting Advisory and implementation for the public sector, starting with the AI readiness assessment.

The work on a review case begins months after the patient has gone home.

Coding happens at the end of the case, under time pressure, from whatever the record offers. When the review notice arrives later, the same record has to be opened again, the coding reconstructed and the justification written from scratch. By then, the colleague handling it may well not be the one who coded the case.

1review noticeThe Medical Service (MD) announces a review of a case billed long ago.
4monthsThat is the gap between discharge and notice; by then, the case is forgotten.
1contested secondary diagnosisThe DRG depends on it, and with it the revenue for the whole case.
2rounds of workOnce to reconstruct the coding, once to justify the objection.

If the passage in the record that supports the secondary diagnosis is identified at first coding, half of this work disappears: that is the 50% less review effort.

The 50% is this agent's headline figure. The four-month gap and two rounds of work per review case reflect a typical case in medical controlling; they are not measurements.

Three steps through the process.

The agent checks the initial coding against the documentation and names the review risk; the clinical coder assigns the codes.

Check the coding against the record

The agent reads the coded diagnoses and procedures and looks for the supporting passage for each one in the case documentation. It flags every code that lacks evidence.

Case 2026-100942, 14 codes checked, 2 without a supporting passage

Name the review risk per code

For each contested code, the agent sets out where a review would typically focus. It names the code, the reference and the share of case revenue at stake.

Risk list with 2 codes, secondary diagnosis E87.6 with no lab value in the record

Prepare the objection with references

The agent compiles the justification with references from the record. Whether the objection is lodged in that form is up to medical controlling.

widerspruch_2026-100942_entwurf.docx, 5 references

What the agent does not do.

It does not code the case.

It shows codes without evidence and names the reference for each. The clinical coder does the coding.

It does not negotiate with the Medical Service.

It presents the draft objection with its justification. Whether and how to object is medical controlling's decision.

It does not predict the outcome of the review.

It points to the places where the documentation is thin. How the Medical Service decides remains open.

Connected systems

  • Hospital information system
  • coding and grouper software
  • MD case management

Operations

  • Deployment modelEU cloud, private cloud or on-premises
  • Data processingGDPR-compliant, no model training on your data
  • Responsible teamsMedical controlling, clinical coders

The questions that come up before the first meeting.

How quickly is the MD Review and Coding Agent ready to use?

A pilot typically runs on your own data within 4 to 6 weeks. The agent connects to your existing systems rather than running as a separate, parallel environment.

Where is the data processed?

EU cloud, private cloud or on-premises. Processing is GDPR-compliant and models are never trained on your data. Details in the Trust Center.

Where does the figure “50% less review effort” come from?

It is based on experience from comparable projects and process benchmarks, not a commitment. We establish the realistic effect for your organisation in the assessment before the pilot.

Related agents.

Intake review, case 2026/04711

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