The evidence is scattered. The money is withheld.

A wound clinician’s proof of medical necessity lives in five places at once — an export from the hospital’s EHR, a photo on someone’s phone, a nurse’s note from the visit before, the referring physician’s history, and whatever gets typed at the bedside. When a payer asks to see that proof, assembling it takes days. By then the payment is usually already held back.

Good care is not the same as a payable record.

Before Medicare covers a skin substitute graft, its coverage policies require the record to establish a specific chain of facts. Every one of them has to be there, written the way the policy expects.

Miss a single link and the claim is denied — not because the treatment was wrong, but because the record could not prove it was necessary.

Requirements summarised from Medicare local coverage determinations L35041 and L36377. Coverage policy varies by contractor and changes; verify against your own payer before relying on it.

01Four weeks of standard caredocumented, and documented as having failed
02Serial measurementslength, width, depth — visit after visit
03Infection and osteomyelitisassessed and recorded, not assumed
04Why this productthe rationale for the one you chose
05Clinical responsewhat changed after you applied it
06Quantity and wastagehow much was used, how much was discarded

Scattered today

EHR exportany certified system
Wound phototaken on a phone
Nurse notesthe visit before yours
Referring physicianhistory and prior care
Bedside entrytyped at the visit

One record

Assembled once, checked every time

Four weeks of standard care
Serial measurements
Infection / osteomyelitis
Why this product
Clinical response
Quantity and wastage

One record, four readers

Clinical notefor the chart
Nurse care planfor the bedside
Coding recommendationfor a certified coder to verify
Audit filewording that holds up

Coming next

Live EHR feedan interface instead of a fileNext
Code set updatesICD-10 · CPT · HCPCS, as they changeNext
Learning layerImages read for progression, stagnation or deterioration · outcomes returned to the recordNext

Nothing is invented

Where a fact is missing, the note says so in brackets rather than filling the gap with something plausible. A note that reads well but cannot be substantiated is worse than an obviously incomplete one — it fails at the moment it matters.

It suggests; a coder decides

Codes come with a rationale and an explicit instruction to verify. The system never selects a final code and never submits a claim. Surgical debridement codes follow the depth of tissue actually removed, not the instrument used — the kind of distinction that decides an audit.

Deterministic first

The current build contains no AI. Notes are produced by explicit rules, so every sentence can be traced to a fact someone entered. Machine learning belongs on top of a trustworthy record, not underneath it.

Want to know more?

We will walk you through a real encounter end to end — intake, the note it produces, the codes it recommends and the checks it refuses to let you past.