Clinical note → claim codes
A wrong-side modifier is caught by the gate before the claim writes.
Open the live lab · pre-loaded to this scenario
Tool-Use & Structured Output
Context
A revenue-cycle agent extracts ICD-10/CPT codes, modifiers, and payer from a clinical note. The first pass applies a left-side modifier to a right-knee film; the schema/consistency gate catches the laterality mismatch and forces a corrective retry.
The decision
The validation gate sits between the model and the claim write — a mis-coded laterality is a denial or an audit finding, so nothing writes to the claim until it validates.
What most miss
People check that the JSON parses, not that it's consistent with the note. On RCM the expensive errors are consistent-looking but clinically wrong — wrong side, wrong modifier.
Stakes
A mis-coded claim is a denial at best and a compliance/audit exposure at worst — at scale that's real leakage.
Studied · Agent & Protocol · verified 2026-07-03
Sources: Revenue-cycle coding (ICD-10/CPT, modifiers, laterality) patterns; Structured-extraction validation + corrective-retry practice