CasePilot: AI-Powered Medical Coding Assistant

Built a sophisticated AI assistant designed to revolutionize medical coding workflows by providing expert-level guidance to healthcare professionals with 20+ specialized tools and intelligent decision-making.

Client
Coding Ahead
Industry
Healthcare Technology
Duration
8 months
Technologies
LaravelOpenAI APIVector SearchReal-time StreamingMySQLRedisEvent Broadcasting

Executive Summary

CasePilot is a sophisticated AI assistant designed to revolutionize medical coding workflows by providing expert-level guidance to healthcare professionals. Built with Laravel and powered by advanced AI orchestration, CasePilot combines 20+ specialized tools with intelligent decision-making to deliver comprehensive medical coding support, compliance guidance, and revenue optimization insights.

Key Achievements:

  • Expert-Level Accuracy: Leverages vector search across comprehensive medical knowledge bases
  • Intelligent Tool Orchestration: Automatically chains multiple specialized tools for comprehensive responses
  • Real-Time Streaming: Provides instant feedback with progress indicators during complex analyses
  • Scalable Architecture: Handles both authenticated users and guest access with intelligent rate limiting
  • Quality Assurance: Includes automated evaluation system for continuous improvement

The Challenge

Medical coding represents one of healthcare's most complex and critical processes, where accuracy directly impacts patient care, regulatory compliance, and revenue optimization. Healthcare professionals face several significant challenges:

Domain Complexity

  • 20,000+ CPT codes with intricate modifier rules and combinations
  • 70,000+ ICD-10 diagnosis codes with specific documentation requirements
  • Constantly evolving guidelines from CMS, NCCI, and OIG
  • Multi-dimensional compliance requirements across federal and state regulations

Business Impact

  • Coding errors cost the industry billions annually in denied claims and compliance penalties
  • Manual research is time-intensive, often taking 15-30 minutes per complex case
  • Expertise gap: Many facilities lack access to certified coding specialists
  • Revenue leakage from under-coding or missed opportunities

Technical Requirements

  • Need for real-time access to vast medical knowledge bases
  • Context-aware guidance that considers multiple factors simultaneously
  • Audit-ready documentation to support coding decisions
  • Scalable solution accessible to practices of all sizes

Solution Architecture

CasePilot addresses these challenges through a sophisticated multi-layered architecture that combines AI orchestration, vector search, and real-time streaming capabilities.

Core Architecture Components

// Agent-based architecture with intelligent tool orchestration
class CasePilotAgent
{
    public static function make(): PrismBuilder
    {
        return Prism::text()
            ->using(Provider::OpenAI, config('prism.providers.openai.default_model'))
            ->withSystemPrompt(static::getExpertPrompt())
            ->withTools(static::getSpecializedTools())
            ->withMaxSteps(6)
            ->usingTemperature(0.2);
    }
}

Real-Time Streaming System

public function createChatStream(Conversation $conversation): void
{
    CasePilotAgent::make()
        ->withMessages($conversation->history_without_tools)
        ->asStream()
        ->each(function ($chunk) use ($conversation) {
            event(new ChatTokenReceived($conversation->id, $chunk->text));

            collect($chunk->toolCalls ?? [])
                ->each(fn ($toolCall) => event(
                    new ToolCallStarted($conversation->id, $toolCall->name)
                ));
        });
}

Technical Implementation

Intelligent Tool Orchestration

CasePilot's core innovation lies in its ability to intelligently chain multiple specialized tools to provide comprehensive guidance. The system includes 20+ purpose-built tools:

Code Search Tools:

  • SearchCptCodesTool - Procedure codes and guidelines
  • SearchIcd10CmCodesTool - Diagnosis codes
  • SearchHcpcsCodesTool - Equipment and supplies
  • SearchCdtCodesTool - Dental procedures

Validation & Compliance:

  • ValidateCodeCombinationTool - NCCI bundling rules
  • SearchNCCIPolicyTool - Medicare coverage policies
  • SearchOIGComplianceTool - Fraud prevention guidelines
  • SearchProgramIntegrityTool - Audit requirements

Documentation Analysis:

  • DocumentationGapAnalysisTool - Identifies missing requirements
  • SearchEMDocumentationTool - E&M level requirements
  • SuggestModifiersTool - Appropriate modifier recommendations

Smart Chaining Logic

The system implements sophisticated decision trees for tool orchestration:

/**
 * For Code Validation Queries - Follow this pattern:
 * 1. Validate the combination (validateCodeCombination)
 * 2. If conflicts found, get NCCI policy details (searchNCCIPolicy)
 * 3. Get modifier details for each code (getCodeDetails)
 * 4. Provide documentation requirements (searchEMDocumentation)
 */

This approach ensures comprehensive coverage while avoiding redundant tool calls.

Conversation State Management

The system maintains rich conversation context through a sophisticated message history system:

public function getHistory(bool $includeTools = false): array
{
    return $this->messages()
        ->orderBy('created_at')
        ->get()
        ->map(fn ($message) => match ($message['role']) {
            'user' => new UserMessage($message['content']),
            'assistant' => new AssistantMessage(
                $message['content'],
                $message['tool_calls'] ?? null
            ),
            'tool' => $includeTools
                ? new ToolResultMessage([new ToolResult(/* tool result data */)])
                : null,
        })
        ->filter()
        ->values()
        ->toArray();
}

Key Features

1. Expert-Level Guidance

CasePilot simulates the expertise of a 20-year veteran medical coder, providing:

  • Multi-dimensional analysis considering codes, modifiers, documentation, and compliance
  • Proactive recommendations beyond immediate questions
  • Revenue optimization insights to maximize appropriate reimbursement

2. Intelligent User Experience

  • Real-time streaming responses with progress indicators
  • Tool execution transparency showing which resources are being consulted
  • Conversation limits to maintain performance (30 messages per conversation)
  • Guest access with IP-based rate limiting for accessibility

3. Quality Assurance System

class AgentEvaluator
{
    public function evaluateAgent(string $agentType, Collection $questions): array
    {
        return $questions
            ->chunk(10)
            ->flatMap(fn ($chunk) => $this->processQuestionBatch($agentType, $chunk))
            ->pipe(fn ($results) => $this->calculateScore($results->toArray()));
    }
}

The evaluation system continuously monitors response quality and accuracy against medical coding standards.

4. Scalable Infrastructure

  • Vector search optimization for sub-second response times
  • Event-driven architecture for real-time updates
  • Flexible rate limiting supporting both authenticated and guest users
  • Comprehensive logging for performance monitoring and debugging

Performance & Scale

Vector Search Optimization

  • Sub-second response times across 20+ knowledge bases
  • Intelligent caching to reduce API calls
  • Parallel processing for complex multi-tool queries
  • Retry logic for reliability under load

Rate Limiting Strategy

public static int $freeMessagesLimit = 10;
public static int $subscriberMessagesMonthlyLimit = 200;
public static int $conversationMessagesLimit = 30;

Tiered access ensures system availability while encouraging subscription conversion.

Real-Time Architecture

The streaming implementation provides immediate user feedback while maintaining system responsiveness:

  • Progressive response building reduces perceived latency
  • Tool execution visibility keeps users engaged during processing
  • Event broadcasting for real-time UI updates

Business Impact

Measurable Outcomes

  • Reduced coding time from 15-30 minutes to 2-3 minutes for complex cases
  • Improved accuracy rates through comprehensive cross-referencing
  • Enhanced compliance with built-in audit trail generation
  • Revenue optimization through identification of missed opportunities

User Experience Improvements

  • Accessible expertise for practices without certified coders
  • Consistent guidance reducing variability in coding decisions
  • Educational value helping users learn while working
  • Audit support with detailed documentation requirements

Scalability Benefits

  • No geographic limitations - accessible anywhere with internet
  • 24/7 availability unlike human consultants
  • Consistent updates reflecting latest regulatory changes
  • Cost-effective scaling compared to hiring additional staff

Technical Challenges Solved

1. Real-Time AI Streaming in Web Environment

  • Challenge: Providing immediate feedback during complex AI processing
  • Solution: Event-driven streaming architecture with progress indicators

2. Complex Tool Orchestration

  • Challenge: Deciding which tools to use and in what sequence
  • Solution: Rule-based decision trees with context-aware tool selection

3. Medical Knowledge Base Integration

  • Challenge: Fast access to vast, frequently updated medical databases
  • Solution: Vector search with intelligent caching and retry mechanisms

4. Conversation Context Management

  • Challenge: Maintaining context across multi-turn conversations with tool results
  • Solution: Sophisticated message history system with role-based filtering

5. Quality Assurance at Scale

  • Challenge: Ensuring consistent accuracy across diverse medical scenarios
  • Solution: Automated evaluation system with continuous improvement feedback

Future Roadmap

Enhanced Capabilities

  • Specialty-specific modules for radiology, pathology, and surgery
  • Integration APIs for EHR systems and practice management software
  • Advanced analytics for practice-level coding performance insights
  • Multi-language support for international medical coding standards

Technical Improvements

  • Parallel tool execution for faster complex queries
  • Advanced caching strategies for frequently accessed information
  • Machine learning integration for personalized recommendations
  • Enhanced evaluation metrics with specialty-specific benchmarks

Platform Expansion

  • Mobile applications for point-of-care coding support
  • Offline capabilities for areas with limited connectivity
  • Team collaboration features for multi-coder practices
  • Educational modules for coding certification training

Conclusion

CasePilot represents a significant advancement in medical coding technology, successfully bridging the gap between complex regulatory requirements and practical healthcare workflows. Through sophisticated AI orchestration, comprehensive knowledge base integration, and user-centric design, the system delivers expert-level guidance at scale.

The project demonstrates mastery of:

  • Advanced Laravel development with AI integration
  • Complex system architecture design and implementation
  • Real-time streaming technologies and event-driven patterns
  • Healthcare domain expertise and regulatory compliance
  • Performance optimization and scalable system design

CasePilot not only solves immediate technical challenges but establishes a foundation for the future of AI-assisted healthcare administration, where expert knowledge is accessible to all practitioners regardless of location or resources.