NLP Enhancement Proposal — 7 Feature Demonstrations

◆ F1 — Valid Provider

NLP detects MD / DO credentials near the signature line and auto-highlights in yellow. NPI number is auto-attached from the provider registry.

◆ F1 — Invalid Provider

RN credential detected as rendering provider — flagged in red. System blocks submission until a valid MD/DO provider is confirmed.

◆ F1 — NPI Auto-Tag

Once a valid provider is detected, the NPI number is automatically appended — eliminating manual lookup time per record.

◆ F1 — Page 2 Continues

Second signature block on continuation page is also scanned. Both valid and invalid providers flagged consistently across all pages.

F1 · Page 1 of 2

Progress Note

Patient: Marcus Rivera | DOS: 09/12/24

DOB: 06/18/1965 | Age: 59 | Gender: Male

Rendering Provider: Dr. Priya Nair, MD NPI: 1023847560

Facility: Sunrise Family Health Clinic, Phoenix AZ

Subjective

Patient presents with a 2-week history of increased thirst and fatigue. Reports poor dietary compliance over the past month. Denies any recent infections or falls.

Objective

BP: 142/90 mmHg. HR: 78 bpm. Weight: 198 lbs. BMI: 30.2. HbA1c: 9.1%. FBS: 228 mg/dL.

Assessment

1. Type 2 Diabetes Mellitus, uncontrolled. 2. Hypertension, Stage 1.

Plan

Increase Metformin to 1000mg BID. Add Lisinopril 10mg daily. Dietary counseling referral placed. Follow up in 6 weeks.

Electronically Signed: Dr. Priya Nair, MD 09/12/24 NPI: 1023847560

F1 · Page 2 of 2

Progress Note — Continuation · Patient: Marcus Rivera · DOS: 09/12/24

Additional Notes

Co-signatures on continuation page:

Co-signed: Dr. Samuel Chen, DO 09/12/24 NPI: 1987654320

Co-signed: Janet Moss, RN 09/12/24 ⚠ Invalid — RN not accepted as rendering provider

NLP Alert: Credential mismatch detected on Page 2. RN co-signature flagged. Reviewer must confirm valid MD/DO rendering provider before record submission.

◆ F2 — Title Scan

NLP reads the document title first — before scanning any clinical content. Title "Emergency Room" sets the encounter context to Inpatient/ED.

◆ F2 — Rule Set Applied

Once encounter type is detected, the correct ICD-10 rule set is loaded automatically. ED rules differ from outpatient progress note rules.

◆ F2 — Logic Locked

All downstream NLP highlights on this record will follow ED-specific coding guidelines — not the universal default logic.

◆ F2 — Page 2 Inherits

Encounter type detected on Page 1 title carries over to all continuation pages — no re-detection needed.

F2 · Page 1 of 2

Emergency Room Note

▶ ENCOUNTER TYPE DETECTED: EMERGENCY / INPATIENT-EQUIVALENT · ED RULE SET LOADED

Patient: Amelia Foster | DOS: 11/03/24

DOB: 09/22/1980 | Age: 44 | Gender: Female

Provider: Dr. Kevin Walsh, MD | Arrival: 14:32 | Disposition: Discharged

Chief Complaint

Patient presents with sudden onset chest pain radiating to left arm, onset 2 hours prior. Associated diaphoresis and mild shortness of breath.

History of Present Illness

Physical Exam

BP: 158/96. HR: 102. RR: 18. SpO₂: 96%. Mild diaphoresis. Heart: tachycardic, no murmur. Lungs: clear bilaterally.

ED Assessment & Plan

Chest pain, rule out ACS. ECG performed — normal sinus rhythm. Troponin x2 negative. Patient stabilised and discharged with cardiology follow-up.

Electronically Signed: Dr. Kevin Walsh, MD 11/03/24 17:45

F2 · Page 2 of 2

Emergency Room Note — Continuation · Patient: Amelia Foster · DOS: 11/03/24

Active Encounter Context: Emergency Room · All NLP highlights on this page follow ED-specific ICD-10 coding rules inherited from Page 1 title detection.

Nursing Notes

Medication Administration Record

Discharge Instructions

◆ F3 — Combo Pair A

Purple highlight = Condition 1 of a combination code. Here: Type 2 Diabetes Mellitus. Alone it maps to E11.

◆ F3 — Combo Pair B

Teal highlight = Condition 2 of the same pair. Here: Chronic Kidney Disease Stage 3. Together with purple → maps to E11.65.

◆ F3 — Visual Logic

Matching colors tell the reviewer these two conditions must be coded together as one combination code — not separately.

◆ F3 — Page 2 Pair

Second combo pair on page 2: Hypertension + CKD maps to I12.9. Both highlighted with a new color pair to visually separate from the first combo.

F3 · Page 1 of 2

Progress Note

Patient: Dorothy Hwang | DOS: 02/14/25

DOB: 12/05/1955 | Age: 69 | Gender: Female

Provider: Dr. Anand Sharma, MD | Facility: Westbrook Internal Medicine

Subjective

Patient reports worsening ankle swelling over 3 weeks. Known history of diabetes with recent labs showing declining kidney function.

Objective

Labs: HbA1c 8.4%, eGFR 42 mL/min (Stage 3 CKD), Creatinine 1.8 mg/dL. BP: 148/94. Pedal edema 2+.

Assessment

1. Type 2 Diabetes Mellitus with Chronic Kidney Disease, Stage 3 → COMBO: E11.65

2. Essential Hypertension — chronic, well-controlled.

Plan

Nephrology referral placed. Continue Metformin with dose adjustment. Renal diet counseling. Repeat labs in 8 weeks.

Electronically Signed: Dr. Anand Sharma, MD 02/14/25

F3 · Page 2 of 2

Progress Note — Continuation · Patient: Dorothy Hwang · DOS: 02/14/25

Additional Assessment Notes

3. Hypertensive Heart Disease with Chronic Kidney Disease, Stage 3 → COMBO: I12.9

NLP Combo Logic: Two combination code pairs detected across this record. Each pair uses distinct color sets to prevent cross-pairing errors. Reviewer confirms pairs before submission.

◆ F4 — Rule Triggered

ER Note detected as outpatient-equivalent encounter. Acute inpatient-only codes are automatically blocked at software level.

◆ F4 — Visual Signal

Blocked acute terms shown in red with strikethrough. Reviewer can see the term was detected but understands it cannot be coded in this context.

◆ F4 — Why It Matters

Acute MI, Acute Respiratory Failure, and similar codes are inpatient-only under outpatient ICD-10 guidelines. Coding them in ER outpatient records creates billing errors.

◆ F4 — Page 2 Block

Blocking rule persists on all pages of the record. Any acute code mentioned in nursing notes or addenda is also suppressed.

F4 · Page 1 of 2

Emergency Room Note

▶ OUTPATIENT ENCOUNTER — ACUTE INPATIENT CODES BLOCKED

Patient: Harold Osei | DOS: 05/22/24

DOB: 03/11/1949 | Age: 75 | Gender: Male

Provider: Dr. Lisa Fernandez, MD | Disposition: Discharged Home

Chief Complaint

Shortness of breath and productive cough for 4 days. Fever up to 101.2°F at home.

Assessment

1. Community-acquired pneumonia, confirmed on CXR.

2. Acute Respiratory Failure BLOCKED · Inpatient-only code · Outpatient rule active

3. Acute MI, unspecified BLOCKED · Inpatient-only code

4. Type 2 Diabetes Mellitus — chronic, stable. Codeable.

Plan

Prescribed Azithromycin 500mg for 5 days. Albuterol inhaler. Return precautions discussed. Follow up with PCP in 3 days.

Electronically Signed: Dr. Lisa Fernandez, MD 05/22/24

F4 · Page 2 of 2

Emergency Room Note — Continuation · Patient: Harold Osei · DOS: 05/22/24

Active Block: Outpatient encounter rule is active. Any acute condition codes identified on this page are automatically suppressed and cannot be selected.

Nursing Notes

Nurse notes patient reported brief episode of acute chest tightness during triage. BLOCKED

◆ F5 — Combo Active

Combination code E11.65 (T2DM + CKD Stage 3) is already captured. This covers both conditions under a single code.

◆ F5 — Duplicate Blocked

When NLP encounters CKD Stage 3 mentioned separately later in the record, it detects it is already included in E11.65 and blocks the individual code.

◆ F5 — Why It Matters

Coding the same condition twice — once in a combo and once individually — creates duplicate billing errors and RAF score inflation in risk adjustment.

◆ F5 — Page 2 Persistence

Duplicate block carries across all pages. If CKD is mentioned again in the discharge instructions, it remains blocked.

F5 · Page 1 of 2

Discharge Summary

Patient: Robert Kimani | Admit: 08/05/24 | Discharge: 08/09/24

DOB: 07/30/1962 | Age: 62 | Gender: Male

Attending: Dr. Nadia Patel, MD | Facility: Oakridge General Hospital

Reason for Admission

Admitted for management of poorly controlled diabetes with evidence of worsening renal function.

Hospital Course

Labs on admission: HbA1c 10.2%, eGFR 38 (CKD Stage 3), Creatinine 2.1.

Discharge Diagnoses

1. Type 2 Diabetes Mellitus with Chronic Kidney Disease, Stage 3 COMBO: E11.65 · ACTIVE

2. Chronic Kidney Disease, Stage 3 BLOCKED · Already in E11.65

3. Essential Hypertension — chronic. Codeable individually.

Electronically Signed: Dr. Nadia Patel, MD 08/09/24

F5 · Page 2 of 2

Discharge Summary — Continuation · Patient: Robert Kimani · Discharge: 08/09/24

Active Duplicate Block: E11.65 combo code is active. Any individual mention of CKD Stage 3 or T2DM is blocked from being coded separately.

Discharge Instructions

Patient instructed to follow up with nephrology for ongoing management of chronic kidney disease BLOCKED

◆ F6 — Negation Word

NLP scans for a curated list of negation words — "denied", "no history of", "ruled out", "negative for", "absent". These are maintained manually by QA team.

◆ F6 — Visual Signal

Negated conditions shown in grey with dashed underline. They are detected but suppressed from coding — reviewer sees them but cannot select them.

◆ F6 — Why It Matters

H&P Notes contain heavy "no history of" language in the Past Medical History section. Without negation detection, these are frequently miscoded as active conditions.

◆ F6 — Page 2 Same Rule

Negation detection active on all pages. ROS (Review of Systems) on page 2 — which is almost entirely negated — is fully suppressed.

F6 · Page 1 of 2

History & Physical Note

Patient: Lorraine Vega | DOS: 03/08/25

DOB: 11/19/1970 | Age: 54 | Gender: Female

Provider: Dr. Thomas Adeyemi, MD

Chief Complaint

Annual wellness exam. Patient reports fatigue and mild joint pain.

Past Medical History

Patient denies hypertension. Reports no history of diabetes mellitus. States no prior cardiac events.

Active conditions: Hypothyroidism (confirmed), Osteoarthritis of the knee (confirmed).

Family History

Mother with Type 2 Diabetes. Father with coronary artery disease. Patient herself denies any personal history of CAD.

Assessment

1. Hypothyroidism — active, on Levothyroxine. 2. Osteoarthritis, bilateral knee — active. 3. Fatigue, unspecified.

Electronically Signed: Dr. Thomas Adeyemi, MD 03/08/25

F6 · Page 2 of 2

H&P Note — Continuation · Patient: Lorraine Vega · DOS: 03/08/25

Review of Systems (ROS)

Constitutional: No fever, no weight loss. Cardiovascular: No chest pain, no palpitations, no edema.

Respiratory: No shortness of breath, no cough. GI: No nausea, no vomiting, no diarrhea.

Neurological: No headaches, no dizziness, no numbness.

NLP Note: Entire Review of Systems section is negated. All 11 conditions detected in this section are suppressed. Zero conditions from ROS will be coded.

◆ F7 — Section Detected

NLP identifies which section of the document it is reading — Subjective, Objective, Assessment, or Plan — before applying highlights.

◆ F7 — HIGH Weight

Assessment section carries the highest coding weight. Diagnoses here are primary codeable conditions — shown with green left border.

◆ F7 — LOW Weight

Subjective section carries low weight. Same disease term mentioned here is shown in grey — informational only, not primary coding target.

◆ F7 — Page 2 Weight

If a diagnosis appears only in Plan and not in Assessment, the system flags it as a medium-weight reference — reviewer decides if it should be coded.

F7 · Page 1 of 2

Progress Note

Patient: James Okonkwo | DOS: 01/17/25

DOB: 08/25/1958 | Age: 66 | Gender: Male

Provider: Dr. Helen Park, MD

Subjective LOW WEIGHT

Patient mentions he has been having chest tightness for 2 days. Also reports longstanding back pain. Both mentioned in passing — informational only.

Objective MEDIUM WEIGHT

BP: 155/95. HR: 80. Labs: LDL 188 mg/dL, HbA1c 8.2%. EKG: normal sinus rhythm.

Assessment HIGH WEIGHT — PRIMARY CODING

1. Type 2 Diabetes Mellitus, uncontrolled — primary diagnosis, codeable.

2. Essential Hypertension — confirmed chronic condition, codeable.

3. Hyperlipidemia — active, on statin therapy, codeable.

Plan MEDIUM WEIGHT

Increase Metformin. Add Amlodipine 5mg. Continue Atorvastatin. Cardiology referral for chest tightness workup.

Electronically Signed: Dr. Helen Park, MD 01/17/25

F7 · Page 2 of 2

Progress Note — Continuation · Patient: James Okonkwo · DOS: 01/17/25

Additional Plan Notes MEDIUM WEIGHT

Referral placed for cardiac workup. Chest tightness mentioned in Plan only — not confirmed in Assessment. Flagged for reviewer decision.

NLP Section Note: "Chest tightness" appears in Plan only. Not confirmed in Assessment section. System flags as medium weight — reviewer must determine if this should be coded as a primary condition.

Section Weight Summary for this Record:

HIGH Assessment → 3 confirmed codeable diagnoses

MED Objective + Plan → Supporting evidence, 1 flagged for review

LOW Subjective → 2 informational mentions, not coded

NLP Enhancement:7 Feature Demonstrations

NLP Enhancement:
7 Feature Demonstrations