AXIOMInpatient Medical Coding

Our solution

An agent that codes the way a coder codes

Axiom follows the same structured workflow as an experienced inpatient coding professional. It reviews the medical record, identifies the diagnoses and procedures that should be coded, looks them up in the Alphabetic Index, and confirms each code in the Tabular List. Throughout the process, it applies the Official Coding Guidelines before submitting the final code set to the MS-DRG grouper.

Each coding decision is documented in a complete coding summary, including the selected code, the clinical evidence from the record, the reasoning behind the decision, and the applicable coding guideline. Codes that were considered but not selected are also documented, with a clear explanation of why they were excluded.

One record in, one coded case out

A real example: a patient admitted with an E. coli bloodstream infection, and what Axiom produces at each point.

  1. Abstraction

    Reads and abstracts the record

    Exactly as a coder abstracts a chart: Axiom reads it in full and pulls out the facts that carry a code, with the diagnoses, the procedures and whether each condition was present on admission. Every fact keeps a pointer to the sentence it came from.

    What Axiom highlighted

    Admitted from the ED with fever and hypotension. Assessment: sepsis due to Escherichia coli, blood cultures ×2 positive. Acute tubular necrosis, creatinine 2.8 mg/dL on admission (baseline 1.0). IV antibiotics started; a central venous catheter was placed for access…

  2. Diagnoses · ICD-10-CM

    Looks the codes up, then verifies them

    The coder's two-step, applied to every condition: search the Alphabetic Index for the term the provider used, then verify the code in the Tabular List before keeping it. The comorbidities that raise severity (CC / MCC) are what this step must not miss.

    Proposed diagnoses
    PDXA41.51Sepsis due to Escherichia coli
    SDXN17.0Acute kidney failure with tubular necrosisMCC
    SDXI10Essential hypertension
  3. Procedures · ICD-10-PCS

    Builds the procedure codes

    ICD-10-PCS codes aren't picked from a list. They are constructed, one axis at a time, and validated against the official tables. Here: the central line placed on day one.

    02HV33Z, built axis by axis
    0SectionMedical and Surgical
    2Body systemHeart and Great Vessels
    HRoot operationInsertion
    VBody partSuperior Vena Cava
    3ApproachPercutaneous
    3DeviceInfusion Device
    ZQualifierNo Qualifier
  4. Rule check · MCE + guidelines

    The model proposes, the rules dispose

    Deterministic validators re-check the whole set against the official coding guidelines and the Medicare Code Editor: sequencing, combination codes, present-on-admission, age and sex conflicts. A violation bounces the set back, with the rule quoted, until it complies.

    Rule check on this case
    Sepsis sequenced as principal Guideline I.C.1.d
    B96.20 rejected: no localized infection is coded here for it to qualify, and A41.51 already names the organism
    POA verified for every diagnosis MCE v43
  5. Grouping · MS-DRG

    Feeds the grouper

    The validated codes go into the official CMS grouper, the same software a coding department uses, which returns the MS-DRG: category, severity level, relative weight. Axiom never guesses this number.

    Grouped result
    DRG 871Septicemia or Severe Sepsis without MV >96 Hours with MCCMDC 18Infectious & Parasitic DiseasesTypeMEDRel. weight1.9425
  6. Coding sheet

    Delivers one sheet per stay

    Everything lands on a single sheet your team can audit: the codes, a plain-language rationale for each, the quoted record wording and the guideline that drove the choice. Anything uncertain is flagged, and codes considered but not kept are listed with the reason they were dropped.

    Summary of the case
    82 y/o · Female1 principal + 5 secondary DxMS-DRG 871 · with MCCDischarged: Home with home health

    An 82-year-old female presented with confusion, fever, and dysuria. She was found to have sepsis due to a urinary tract infection with Escherichia coli confirmed on urine culture, complicated by severe sepsis with acute hypoxemic respiratory failure requiring supplemental oxygen and acute kidney injury from sepsis and hypoperfusion. She was treated with resuscitation including IV fluids, with lactate normalization, creatinine improvement, and eventual weaning from oxygen over the hospital stay. The patient was discharged home with home health services.

    Why this coding

    I assigned A41.51 (Sepsis due to Escherichia coli) as the principal diagnosis because the patient was admitted for treatment of sepsis and the urine culture grew E. coli, making the systemic infection the condition chiefly responsible for the encounter. Secondary codes capture the localized source (N39.0 urinary tract infection with B96.20 identifying E. coli as the causative organism per the use-additional-code instruction on N39.0), the severe sepsis manifestation (R65.20), and the acute organ dysfunctions (J96.01 acute respiratory failure with hypoxia and N17.9 acute kidney failure). The grouper assigned MS-DRG 871 based on this combination of codes.

    MS-DRG 871
    Septicemia or Severe Sepsis without MV >96 Hours with MCC
    82 y/o · F · disch. Home with home health
    Grouped
    Severity
    with MCC
    MDC 18
    Infectious & Parasitic Diseases
    Type
    MED
    Rel. weight
    1.9425
    Diagnoses & procedures
    PDX
    A41.51
    Sepsis due to Escherichia coli [E. coli]MCC
    I chose A41.51 as the principal diagnosis because the record states the patient was ‘treated for sepsis’ and the ‘urine culture grew Escherichia coli,’ with documentation of ‘Sepsis due to a urinary source.’ Per Guideline I.C.1.d.4, when sepsis with a localized infection is the reason for admission, the underlying systemic infection code is assigned first as principal. A41.51 specifically identifies E. coli as the causative organism, matching the culture result.
    “treated for sepsis”
    “urine culture grew Escherichia coli”
    Rule I.C.1.d.4Section I · 4) Sepsis or severe sepsis with a localized infectionICD-10-CM Official Guidelines for Coding and Reporting
    “a code(s) for the underlying systemic infection should be assigned first and the code for the localized infection should be assigned as a secondary diagnosis”
    Rule I.C.1.d.3Section I · 3) Sequencing of severe sepsisICD-10-CM Official Guidelines for Coding and Reporting
    “the underlying systemic infection should be assigned as principal diagnosis followed by the appropriate code from subcategory R65.2”
    confidence 100%
    SDX
    N39.0
    Urinary tract infection, site not specifiedCC
    I chose N39.0 as a secondary diagnosis because the record documents ‘Urinalysis was consistent with a urinary tract infection’ and ‘Urinary tract infection due to Escherichia coli, present on admission.’ Per Guideline I.C.1.d.4, the code for the localized infection is assigned as a secondary diagnosis when sepsis is the reason for admission. No specific site such as cystitis or pyelonephritis was documented, so N39.0 (site not specified) is the correct code; the Excludes1 list does not include unspecified UTI.
    “Urinalysis was consistent with a urinary tract infection”
    “Urinary tract infection due to Escherichia coli, present on admission”
    Rule I.C.1.d.4Section I · 4) Sepsis or severe sepsis with a localized infectionICD-10-CM Official Guidelines for Coding and Reporting
    “the code for the localized infection should be assigned as a secondary diagnosis”
    confidence 100%

    Run a case of your own to read one in full.

    Try it on a sample case

Two ways to run it

Autonomous by design, reviewed if you choose

Axiom doesn’t replace your coders’ judgment. It removes the reading. The output is identical either way; the only choice is who signs off.

Straight through

Cases are coded end-to-end and flow directly onward: no queue, no backlog. Cases that trip a flag can still be held for a human look; the rest don’t wait.

  • Coded the moment the record is complete
  • Flagged cases held; clean cases released
  • Full audit trail on every case, always

With review

Your team receives the finished sheet instead of a chart: codes, reasons, quoted evidence. Reviewing takes minutes; the judgment stays with the coder, the reading doesn’t.

  • Approve, correct or query, all on one page
  • Uncertainties pre-flagged, with the reason
  • Rejected codes visible, so nothing hides

Deployment

Your data, your choice of walls

The same system runs both ways, so pick the one your security team prefers. On-premise, nothing leaves your network at all. In the cloud, records are de-identified inside your walls first, so no identifiable patient data ever leaves the hospital.

On-premise

Everything inside your network

Your hospital
Medical recordsCoding by AxiomCoded cases

Axiom runs on a server you host. No internet connection is required: records are processed where they already live, and nothing crosses your firewall. Updates ship as versioned images your IT team installs on their schedule.

Cloud

De-identified before it leaves

Your hospital
Medical recordsDe-identification
de-identified record leaves
Axiom cloud
Coding by Axiom
coded case returns
Your hospital
Coded cases

A de-identification step inside your network strips names, identifiers and dates before anything is sent. Axiom codes the de-identified record and returns the result to your systems. Nothing identifiable ever leaves the hospital.

See it on your own cases

Try the live demo with a sample record, or run a pilot on records your team has already coded.

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