An AI-powered medical billing assistant that translates clinical documentation into accurate ICD-10, CPT, and E&M codes while flagging denial risks.
Install & Download
1. ClawHub CLI
The fastest way to install a skill directly from the registry.
npx clawhub@latest install medical-billing-coder
2. Manual Installation
Copy the skill folder to one of these locations
~/.openclaw/skills/ <project>/skills/ Priority: Workspace > Local > Bundled
3. Prompt Installation
Copy this prompt to OpenClaw to install it automatically.
Help me install medical-billing-coder using Clawhub. If Clawhub is not installed, install it first (npm i -g clawhub).
Prefer to download?
Get the raw skill files in a ZIP archive.
What is Medical Billing Coder?
The Medical Billing Coder is an essential technical skill designed for clinicians, billers, and practice managers looking to streamline their revenue cycle management. By leveraging Openclaw Skills, this agent analyzes clinical documentation to suggest highly accurate ICD-10 diagnosis codes, CPT procedure codes, and E&M visit levels. It provides a structured audit trail and confidence scores for every suggestion, ensuring that healthcare providers can verify data before claim submission.
This tool acts as a powerful decision-support layer, helping to reduce manual coding errors and prevent revenue leakage. It is built to handle complex clinical notes and de-identified visit summaries, transforming plain-language descriptions into industry-standard billing codes while maintaining strict data privacy standards.
Medical Billing Coder Use Cases
- Translating patient visit summaries into specific ICD-10-CM diagnosis codes.
- Identifying the correct E&M visit level (99202-99215) based on documented time and medical decision-making complexity.
- Cross-referencing CPT procedure codes with 2026 Medicare reimbursement rates for financial forecasting.
- Generating a structured, coded superbill ready for final review and practice management ingestion.
- Validating code combinations against NCCI bundling edits to proactively prevent claim denials.
How Medical Billing Coder Works
- The user inputs a de-identified clinical note, a procedure description, or specific trigger phrases into the interface.
- The Openclaw Skills logic parses the documentation to identify key clinical indicators, procedures performed, and time-based metrics.
- The agent matches findings against the CMS ICD-10-CM database and references common CPT code frameworks.
- It evaluates Medical Decision Making (MDM) components to recommend the appropriate E&M visit level.
- The skill performs a validation check for NCCI edits and potential code bundling conflicts.
- A final report is generated containing code suggestions, confidence percentages, and estimated reimbursement values.
Medical Billing Coder Setup
To get started with this medical billing assistant, ensure you have the Openclaw Skills environment ready.
Optional: If you require real-time NCCI edit validation, configure your CMS API key in your environment variables:
export CMS_API_KEY="your_cms_api_key_here"
Note: Always ensure that no patient-identifiable information (PHI) is included in the clinical text processed by the skill.
Medical Billing Coder Data Schema & Taxonomy
The skill organizes its data using standard medical taxonomy and CMS public data structures:
| Component | Data Source | Description |
|---|---|---|
| ICD-10-CM | CMS Official Database | Official diagnosis codes and specificities |
| CPT Reference | AMA Public Lists | Numerical procedure code identification |
| Fee Schedule | CMS Fee Schedule | RVU and Medicare reimbursement rates |
| NCCI Edits | CMS NCCI | National Correct Coding Initiative bundling rules |
| Audit Trail | Logic Logs | Breakdown of MDM and time-based E&M logic |
Medical Billing Coder Advanced Features
- Real-time NCCI bundling validation via optional CMS API integration to identify procedures that cannot be billed together.
- Automated undercoding detection to flag visits that qualify for higher E&M levels based on documented complexity.
- Telehealth-specific coding support, including appropriate modifiers like -95 for virtual visits.
- Comprehensive superbill generation that integrates ICD-10, CPT, and modifiers into a single exportable format.
- Revenue leakage analysis using Openclaw Skills to compare recommended levels against common billing pitfalls.
SKILL.md
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