Code suggestions

Code suggestions read the saved note and propose diagnoses that are documented in it. They are proposals for you to review, never codes added on their own.

Run suggestions

1. Open Visit workflow → Coding worksheet and confirm the date of service.
2. Choose Suggest codes. Terra shows the credit estimate and how many sources will be read.
3. Decide whether to include the transcript. By default only the saved note sections and signed amendments are sent.
4. Confirm.

Only clinicians can run suggestions. A visit allows up to 50 runs.

Read a suggestion

Each candidate shows:

• The documented phrase and a plain-language description.
• The exact excerpt from the note that supports it, with the section it came from.
• Up to three ICD-10-CM codes, each checked against the release for your date of service.
• A specificity prompt when the note lacks detail the code needs, such as laterality, acuity, type or stage. For example: "Laterality not documented: right, left or bilateral?"
• Its documentation state: confirmed, possible, history or ruled out.

How Terra treats uncertainty

• If the excerpt contains uncertainty language such as "possible", "likely", "rule out" or "?", the candidate is shown as possible even if the model called it confirmed. Terra never upgrades a possible diagnosis.
• History items are shown separately from current problems.
• Ruled-out findings are shown but cannot be added.
• A finding that appears only in the transcript cannot be added until it is documented in the note.

Codes Terra corrects

If a proposed code is not in the release for your date, or is only a category header, Terra drops it and offers up to three valid codes nearby, showing the original proposal so you can see what changed.

Add to the worksheet

Choose Add to worksheet on a code. It is added as an unsaved line marked "Suggested — review", with the excerpt filled in. Save, then approve as usual.

Credits

Each run reserves its estimate and settles the actual usage, even if the output is rejected because the visit changed. If the provider's answer is unclear, the reservation is held for reconciliation and the run is not retried automatically.