VALIDO INTELLIGENCE CODING REPORT · DAILY AUDIT
What your coders missed
Sample Medical Center · visits of Oct 1 – Oct 2, 2026 · delivered Oct 3, 2026, 12:56 PM
DEMO — synthetic data · 150 visits reviewed · 3 coders · 5 physicians · patients identified by ID only, never by name
01 · SUMMARY OF THE DAY · 150 visits reviewed one by one
We compared every claim your coders sent with the full clinical note. 130 visits have a possible missing code, 83 of them affect risk adjustment (HCC), and 20 services were done but never billed.
CLEAN VISITS
20
nothing missing
POSSIBLE MISSING CODES
130
visits to review
HCC GAPS
83
risk adjustment
BLOCKED
1
documentation needed
Estimated opportunity$184,815
HCPCS services not billed — collectable now (20)$1,563.10
HCC diagnoses documented but not on the claim — estimated annual impact (83)$183,252
HCC impact is an annual estimate based on public Medicare risk-adjustment values, counted once per patient and condition if documented and submitted in the year. Not a guarantee of payment. Service amounts are estimates based on public Medicare rates.
02 · PRIORITY CASES · ranked by impact · top 5 of 320
PT-SM-0135 ENC-SM-0135 · Oct 2, 2026 · coded by EMP-02
$18,026est. annual impact · HCC
Codes sentZ51.5
Possible missC79.9 Secondary malignant neoplasm of unspecified site · alternatives: C79.51, C78.7, C78.00, C79.31
WhyThe note documents Secondary malignant neoplasm of unspecified site (C79.9) in the assessment and the claim does not include it. It affects risk adjustment (HCC V28).
Evidence“progression of cancer with multiple metastases”
ValidationReady for the coder · HCC Yes · Rule TM-0286
PT-SM-0106 ENC-SM-0106 · Oct 2, 2026 · coded by EMP-01
$8,747est. annual impact · HCC
Codes sent— none —
Possible missC34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung · alternatives: C34.91
WhyThe note documents Malignant neoplasm of unspecified part of unspecified bronchus or lung (C34.90) in the assessment and the claim does not include it. It affects risk adjustment (HCC V28).
Evidence“Malignant neoplasm of unspecified part of unspecified bronchus or lung”
ValidationReady for the coder · HCC Yes · Rule TM-0281
PT-SM-0092 ENC-SM-0092 · Oct 2, 2026 · coded by EMP-02
$4,751est. annual impact · HCC
Codes sentZ96.651
Possible missM06.9 Rheumatoid arthritis, unspecified · alternatives: M05.79
WhyThe note documents Rheumatoid arthritis, unspecified (M06.9) in the assessment and the claim does not include it. It affects risk adjustment (HCC V28).
Evidence“Rheumatoid Arthritis, well-managed but experiencing post-operative stiffness”
ValidationReady for the coder · HCC Yes · Rule TM-0175
PT-SM-0018 ENC-SM-0018 · Oct 1, 2026 · coded by EMP-01
$3,442est. annual impact · HCC
Codes sent— none —
Possible missK70.30 Alcoholic cirrhosis of liver without ascites
WhyThe note documents Alcoholic cirrhosis of liver without ascites (K70.30) in the assessment and the claim does not include it. It affects risk adjustment (HCC V28).
Evidence“Alcoholic cirrhosis of the liver without ascites”
ValidationReady for the coder · HCC Yes · Rule TM-0153
PT-SM-0059 ENC-SM-0059 · Oct 1, 2026 · coded by EMP-03
$3,265est. annual impact · HCC
Codes sent— none —
Possible missF11.20 Opioid dependence, uncomplicated · alternatives: F11.21, F11.10
WhyThe note documents Opioid dependence, uncomplicated (F11.20) in the assessment and the claim does not include it. It affects risk adjustment (HCC V28).
Evidence“Opioid Dependence, in remission.”
ValidationReady for the coder · HCC Yes · Rule TM-0258
FINDINGS BY CODER · FULL QUEUE
| CODER | FINDINGS |
|---|
| EMP-01 | 103 |
| EMP-02 | 130 |
| EMP-03 | 72 |
WHAT THE CODER DOES NEXT
Every finding comes with the evidence from the note, the rule that triggered it and alternatives. The coder reviews it, corrects the claim, and the case closes. 315 more cases wait in the full review queue for this day.