The ICD-10 codes in the right sidebar of an encounter come from the assessment you wrote, not from a generic top-of-mind list. The system reads the diagnostic claims in the assessment and matches them to codes that fit those claims specifically. Here is how to read and tune the suggestions.
Where the suggestions come from
When AriaMD finishes processing a note, the coding model reads the Assessment section (and the HPI for context) and extracts the diagnostic claims you made. Each claim becomes a candidate code. The model then ranks the candidates by:
- Specificity match. If your assessment specifies “moderate, recurrent, without psychotic features,” the system selects F33.1 over F33.9.
- Confidence. Each suggestion has a confidence score based on how clearly the documentation supports the code.
- Specialty rules. If your workspace has specialty-specific rules configured, those filters apply.
You see the result in the right sidebar, ranked by relevance to the encounter, with the primary code first.
Why a code might be missing
If a diagnosis is in your assessment but the suggestion is not in the sidebar, three common causes:
- The assessment language was ambiguous. A statement like “depression, possibly recurrent” may not produce a confident enough match. Edit the assessment to be specific.
- A required specifier is missing. If your code requires a severity or sequence specifier and the documentation does not include one, the system flags a coding gap rather than guessing. Look for the gap indicator in the sidebar.
- The diagnosis is in the HPI but not the Assessment. The model weights the Assessment section for code extraction. Move the diagnostic claim into Assessment.
You can always add codes manually using the search field at the bottom of the sidebar.
Add-on codes
Add-ons (90785 for interactive complexity, 99417 and 99418 for prolonged services, smoking and alcohol counseling codes) get suggested when documentation supports them. The system checks for the specific elements each add-on requires before suggesting.
For interactive complexity (90785), the system looks for at least one of: high-risk behavior, mandatory reporting, communication barrier, family conflict relevant to care. If none are documented, the code is not suggested. If you have a clinical reason to add it, document the supporting element first.
How to override suggestions
Each suggestion has Accept and Reject buttons. Override anything that does not fit. The system records the override, and over time the suggestions adapt to your group’s coding style.
Overrides do not retrain the global model. They tune the suggestions for your workspace. Other practices on Nextvisit are not affected by your overrides.
Configure default behavior
Open Settings, Tools and AI, then Insurance Coding. The configurable settings:
- Default code sets. The library of ICD-10 codes the model considers. Most behavioral-health practices use the default psychiatric set. Specialty practices (addiction medicine, child psychiatry) can switch to a more focused set.
- Confidence threshold. The minimum confidence required before a code surfaces as a suggestion. Higher thresholds reduce noise; lower thresholds catch more but include weaker matches. Default is appropriate for most practices.
- Specialty-specific rules. Custom filters for your group. Useful for practices with documented coding policies (always include Z codes for social determinants, always suggest E and M for medication monitoring, etc.).
Pre-sign-off coding gaps
When you sign an encounter, the system checks whether documented diagnoses have accepted codes. If a diagnosis in the Assessment does not have an accepted code, you see a gap warning. Add the code or accept a suggestion before signing, or sign with the gap if it is clinically appropriate. The warning does not block signing.
When suggestions are wrong
If the suggested codes consistently miss in a specific way (always too generic, always missing a comorbid condition,
always suggesting an add-on that does not apply), email hello@nextvisit.ai with two or three sample encounter IDs and
the override pattern. The team can review the workspace coding configuration and adjust the rules.