Surgical Code Agent
Map surgeries from medical documents to standardized codes for accurate claims and analytics
Description
Challenge:
Medical invoices and records contain surgery descriptions that vary widely in terminology, language, and abbreviations. Manual mapping of these procedures to standardized surgical codes is slow, error-prone, and inconsistent, leading to misclassification, claim disputes, and inaccurate reporting. Ambiguous or unmatched entries further complicate downstream adjudication and analytics, making compliance and audit trails difficult to maintain.
How It Works:
The Surgical Code Agent processes structured surgery entries from invoices or medical records. Abbreviations are expanded and terminology normalized before searching a Surgical Code mapping repository in both Bahasa and English. Each surgery is matched 1:1 to the closest code and associated surgical group. Ambiguous or unmatched entries are marked as null to ensure accuracy. The agent outputs structured JSON suitable for claims adjudication, reporting, and compliance workflows, while maintaining audit logs for traceability.
Benefits:
Achieves 95–98% accuracy in surgery-to-code mapping.
Reduces manual mapping effort and errors.
Ensures strict 1:1 mapping for regulatory and audit compliance.
Standardizes surgical coding across languages and abbreviations.
Provides structured, auditable outputs for claims and analytics.
Resources
Features
Automates the mapping of surgical procedures to standardized codes, ensuring accurate and compliant categorization for claims and reporting. Handles multi-language terminology and common medical abbreviations.
Features & Capabilities:
Abbreviation Expansion: Converts shorthand surgery terms to full medical terminology.
Multi-Language Mapping: Searches mapping repository in English (SURGEON_NAME_ENG) and Bahasa (SURGEON_NAME).
1:1 Code Mapping: Each surgery entry maps to a single code; unmatched entries are null.
Surgical Group Assignment: Retrieves corresponding SURGEON_GROUP for each mapped code.
Validation & Audit: Maintains logs of mapping decisions for quality and compliance.
Structured Output: JSON array with surgery_extracted, surgery_derived, mapped_code, and surgeon_group fields.
Operating Blueprint
Knowledge Sources:
Pre-extracted surgery entries from invoices or medical records.
Surgical Code mapping repository.
Medical terminology and abbreviation reference guides.
Business Rules:
Mandatory Mapping Rule: Each surgery must map to one code; otherwise, return null.
Abbreviation Rule: Expand all recognized shorthand terms before mapping.
Multi-Language Rule: Prioritize English mapping; fallback to Bahasa if not found.
Validation Rule: Ensure output JSON contains all required fields for each surgery entry.
Tool Workflow:
Receive structured surgery entries.
Expand abbreviations and normalize terminology.
Perform fuzzy/vector search against Surgical Code mapping file.
Identify closest match in English or Bahasa columns.
Retrieve mapped SURGEON_CODE and SURGEON_GROUP; assign null if unmatched.
Emit structured JSON for downstream claims, analytics, and reporting.
Maintain audit logs of mapping decisions for compliance.
Badges
Classification
Capabilities
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