The moment it solves
The case is closed. The coding still has to be right.
Surgeons should not be reconstructing CPT from memory at the end of a long list. CodeIQ OR proposes the highest supportable line and waits. Most of the adjudication set was retrospective — concordance with what was paid is not a claim that the engine caused the payment.
How it works
Prepared work. Physician still decides.
- 01
Read the operative note
Primary procedure, laterality, implants, and bundling constraints.
- 02
Propose the supportable line
Highest supportable coding, with ambiguity routed to the surgeon instead of guessed.
- 03
Surgeon confirms
The comparison target for the historical benchmark is the operating surgeon's billing-record coding — agreement, not clinical ground truth.
Evidence of value
Classed evidence. Not every number is cash.
MEASURED PERFORMANCE
96.1%
Adjudication concordance on billed + fully adjudicated engine-suggested lines
Of billed + fully adjudicated engine-suggested lines, 96.1% were paid. n=1,436 lines. Most cases were retrospective.
How this was measured
OpAgent Benchmark: paid rate among billed and fully adjudicated lines the engine suggested. Concordance with what was paid, not a causal claim that CodeIQ caused the payment.
Sample: n=1,436 lines
Do not imply CodeIQ caused the paid outcome. Most cases were retrospective.
Source: OpAgent Benchmark
MEASURED PERFORMANCE
1.2%
Strict coding/bundling false-positive rate
Strict coding/bundling false positives in the benchmark adjudication set.
How this was measured
OpAgent Benchmark: strict coding/bundling false-positive rate.
A false-positive rate is not an accuracy percentage and not an ROI figure.
Source: OpAgent Benchmark
MODELED OPPORTUNITY
$275,682
Tier A modeled opportunity
Modeled. Not recovered cash. Not caused-by-CodeIQ revenue.
How this was measured
OpAgent Benchmark: Tier A modeled opportunity on the adjudicated surgical set.
Modeled opportunity, not realized recovery.
Source: OpAgent Benchmark
MODELED OPPORTUNITY
$104,348
Tier B expected value
Modeled expected value. Not recovered cash.
How this was measured
OpAgent Benchmark: Tier B expected value on the adjudicated surgical set.
Modeled, not realized recovery.
Source: OpAgent Benchmark
MODELED OPPORTUNITY
~$509
Tier A modeled opportunity per adjudicated case
Tier A modeled opportunity divided across adjudicated cases.
How this was measured
OpAgent Benchmark: ~$509 Tier A per adjudicated case.
Modeled per-case opportunity, not recovered cash per case.
Source: OpAgent Benchmark
MEASURED PERFORMANCE
97.5%
Agreement with surgeon-coded historical cases
Weighted combined agreement across 359 held-out surgical cases spanning 5 procedure families, scored against the operating surgeon's own billing-record coding — a historical agreement benchmark, not clinical ground truth.
How this was measured
The validation dataset is 3,951 de-identified operative cases (2018–2026) from a single high-volume arthroplasty and trauma practice, held as a Limited Data Set. Cases were split with a fixed seed into few-shot, evaluation, and locked-test partitions; the locked test set was physically quarantined and never viewed during prompt iteration. The comparison target is the operating surgeon's billing-record CPT assignments. Prompt changes were accepted only when the evaluation set improved. 4.2% of cases self-flagged as ambiguous and routed to human review.
Sample: n=359 locked test set
Period: April 2026
Historical surgical coding agreement, not clinical ground truth, not adjudication, and not implied across other OpAgent agents.
Source: April 2026
Methodology / caveat
Adjudication concordance and strict coding/bundling false-positive rate are one proof class. Economic figures are modeled opportunity, not recovered cash. The 97.5% figure is historical surgical coding agreement against surgeon billing-record CPT assignments — not clinical ground truth, and not a claim that CodeIQ caused paid outcomes. Most cases were retrospective.
Full historical-agreement methodology →
Where it connects
The rest of OpAgent is already in the room.
- Wrap
Operative documentation that feeds the coding pass.
- RadiologiQ
Imaging that often sits in the same episode.
- AdminQ
The authorization packet that should have matched this case.
- Proof
Locked-test methodology for historical agreement.