The problem
In orthopedics, the note decides whether the claim gets paid. Payers look for laterality, imaging findings, failed conservative care and visit work that stands apart from a same-day procedure. Kodiak Solutions reported in March 2026 that missing-authorization and medical-necessity denials accounted for virtually all of the increase in denial rates from 2024 to 2025, as our guide to common orthopedic claim denials explains.
Found after submission, a gap means records requests, appeals and delay. A knee replacement note without dated nonoperative care can fail payer criteria: the Aetna, Cigna (EviCore) and Carelon policies in our appeal guide generally require imaging-confirmed advanced arthritis, functional limitation and about 12 weeks of failed nonoperative care.
How it works
Read the note where it lives: Rette’s AI agents connect to athenahealth or eClinicalWorks and read operative and clinical notes directly. Using another EHR? Ask about your EHR.
Flag gaps before coding: Rette flags documentation gaps in the note before it is coded, so they can be resolved in the chart.
Suggest codes from the note: Rette suggests CPT and ICD-10-CM codes and modifiers, and your coders review them and make the final call.
Check again before submission: Before the claim goes out, Rette flags remaining gaps and checks the claim against NCCI edits and Medicare NCD and LCD rules.
What you get
Documentation gaps flagged before coding, not found later on a remittance
A second check before submission, including NCCI edits and Medicare NCD and LCD rules
Code and modifier suggestions from the note, with coders in the loop
No rip-and-replace, no data migration and no new system for staff to learn
A HIPAA-compliant platform that has completed SOC 2 Type I
Built for orthopedics
Rette is built with orthopedic surgeon advisors. These orthopedic details often decide payment, so they belong in the note before coding:
Injection days: modifier 25 needs significant, separately identifiable visit work beyond the decision to inject.
Decision for surgery: modifier 57 needs the decision to operate documented at a visit on the day of or day before a 90-day procedure.
Medical necessity: a joint replacement note needs imaging findings, functional limits and dated nonoperative care, or the claim risks CO-50.
Laterality: M17.11 is right-knee osteoarthritis and M17.12 the left, so a side mismatch can return as CO-11.
Frequently asked questions
Does Rette change how our surgeons document?
Your surgeons keep documenting in the EHR they use today. Rette’s agents read those operative and clinical notes directly and flag documentation gaps before coding. Your surgeons and coders decide how to resolve each flag, following your practice’s own documentation and amendment policies, and staff have no new system to learn.
What is the difference between a documentation gap and a coding error?
A documentation gap means the note doesn’t support a code or a payer’s criteria, such as an injection-day visit that shows no work beyond the decision to inject. A coding error means the wrong code or modifier was chosen from a complete note. Rette flags gaps before coding, then suggests codes and modifiers for your coders to review.
How does Rette protect patient data?
Rette is HIPAA compliant and has completed SOC 2 Type I. Practice-specific questions from your compliance team, such as how EHR access is set up and how data is handled, are answered on a call before you commit, so bring them when you request a demo.
Related guides
Read More
Denials & Appeals
The Most Common Orthopedic Claim Denials in 2026, and How to Prevent Them
Oct 14, 2026
Read More
Denials & Appeals
How to Appeal a Medical-Necessity Denial for a Knee or Hip Replacement
Oct 14, 2026
Read More
Coding & Modifiers
Can You Bill an E/M With Modifier 25 on an Orthopedic Injection Day?
Oct 14, 2026
Key terms
Rette reads the operative note in the EHR you already use, suggests codes and checks claims against payer and NCCI rules before submission.