Inside the payer-aware recheck: catching E/M, CPT, and ICD-10 gaps before signature

Most documentation tools stop at the note. A wound-native platform runs a live payer-aware recheck against E/M, CPT, and ICD-10 rules the moment you hit sign — turning compliance from a post-visit audit into a pre-signature safety net powered by WISER claims and compliance.

What the recheck actually inspects

• E/M level support — history, exam, and MDM elements are compared to the level being billed. If time-based billing is used, total time and its components are checked.
• CPT justification — debridement depth, surface area, and technique are matched against the CPT selected. Selective vs excisional language is flagged when it conflicts with the code.
• ICD-10 specificity — laterality, ulcer stage, and underlying etiology (diabetic, venous, arterial, pressure) are checked for the highest specificity the note supports.
• Payer-specific LCDs — frequency limits, prior conservative care duration, and vascular workup requirements for the patient's payer are surfaced inline.

Why it runs at signature, not at billing

Catching a missing ABI reference or an unstaged pressure ulcer three weeks later means an addendum, a rebill, or a write-off. Catching it while the patient is still in the room means one sentence spoken, one field completed, one clean claim.

What providers see

A short list of gaps, each with the rule that triggered it and a one-tap path to resolve — dictate the missing detail, pick from a structured option, or acknowledge the exception. No leaving the chart, no separate coder queue.

See how it fits alongside the coding agent and the broader AI-powered EMR for wound care.