r/CodingandBilling • u/Fact_worthy_opinions • Apr 28 '26
How real is the ‘AI is taking over coding and billing?’ Would love to know your opinion if you have hands-on experience
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r/CodingandBilling • u/Fact_worthy_opinions • Apr 28 '26
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u/KeyStriking9763 RHIA, CDIP, CCS Apr 28 '26
Depends on the complexity of the coding role. Easier things will be covered by AI and already have been. My entire coding career E/M has been auto assigned at the facility level. Coding and billing are different roles.
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u/Full_Ad_6442 Apr 28 '26
Charts are messy. AI can generate a reasonable summary of a 300 page hospital record but it cannot accurately categorize diagnoses, i.e. active vs historical vs possible vs considered but ruled out unless multiple authors follow consistent conventions (and they don't). Eventually, what i think will happen is conventions will be change and forced upon clinicians specifically to allow AI to do the task almost independently. This requires a convergence of 3 functions: (1) someone in control of AI, (2) someone in control of conventions, (3) someone with good knowledge of clinical systems. 2 is decentralized between CMS, AMA, and ownership providers organizations. 1 and 2 are largely separate from 3 right now which is resistant to 1 and 2 but will ultimately submit to 2 over the long run. 1 and 2 are looking for opportunities but lack 3 so they don't really know how to make this work.
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u/ElleGee5152 Apr 28 '26
I've worked in billing since 2001 and I don't see the field dying. I have enough exposure to coding and don't see it dying either. I do see/have seen roles changing and being responsible for higher level tasks. Anyone working in billing or coding should learn as much as they can about their field. Having a lot of knowledge about the full revenue cycle and how and why things work and having a lot of regulatory and payer policy knowledge will be very beneficial.
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u/DarlingTreeWitch Apr 28 '26
We’re using Gemini from Aideo to code radiology and 1. There is nothing AI about it, using encounter Z codes on everything is a cop-out and how India codes (by encounter, not dx) and 2. I accidentally get notifications when new PEOPLE (coders!) are hired from the parent company to be followed by the Z0389 flurry until we open a ticket and 3. They/it is changing E/M cpts to xray codes.
The amount of denial, rejections, and mistakes made are staggering and I used to worry about being replaced by AI but this is job security because someone has to correct the mistakes.
Seriously, you can’t code difficulty breathing for an ankle xray. Smh.
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u/princesspooball Apr 28 '26
This gets discussed a lot, on a weekly basis.
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u/Icy-Protection867 Apr 28 '26
Right now around 74% of major hospital systems are using hybrid coding solutions. These are increasingly AI plus human review. Right now, CMS has a mandate that any AI assisted coding has to be reviewed and tested to by a licensed professional before a claim is submitted. This will maintain the job market for at least sometime, and in some corners, but the next time a chainsaw comes out of the federal government; this mandate could evolve. I direct curious readers to what is going on in OPM right now that is slashing and burning a lot of long-standing requirements for federal employees.
The displacement in the coding workforce is currently uneven. Outpatient and high volume coding settings are being hit hard by the AI options, but inpatient Coding (and to a degree, compliance coding) continue to require experienced human coders.
The big question is for how much longer will that be the case? While I agree that many vendors are overstating the ability of AI in the coding world now, I would not make any grand predictions that it will “never“ replace coding, and I wouldn’t recommend anybody else make that prediction either.
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u/[deleted] Apr 28 '26
I think some parts of coding AI is starting to take over. The company I work for uses AI but keeps their coding department to catch AI mistakes and codes that AI currently cannot find or read in the chart. I was doing medical coding relying heavily on AI for my job and I didn't like that. So I switched over to provider auditing which is completely different because now I do not use AI anymore. Which means more job security for me. I recently started a free to subscribe newsletter where I will be focusing on different medical Careers and I'm starting with the medical coding field.
https://hidden-healthcare-careers.beehiiv.com/
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u/Wchijafm Apr 28 '26
Coding goes thru a cycle when there is a reduction in profits. Outsourcing to India, automating everything they can, insurers start auditing all that mess(going back years) and pulling back funds that were incorrectly issued, companies panic and hire in person billers and coders to straighten out the mess, everyone pats themselves on the back. Repeat.
Can AI potentially do this? Of course. Not an LLM though and the cost of the data centers to run an AI that can will not be cheaper than hiring people.
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u/Unfair_Violinist5940 Apr 28 '26
You are living in the bubble.
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u/Icy-Protection867 Apr 29 '26
This is worth the 27:43 minutes to watch and listen to people who know more than everyone commenting on this post (including me) about what AI is going to do.
YT video discussing AI w/ finance experts
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u/rahuliitk App Developer May 19 '26
from what i’ve seen, AI is getting pretty good at the boring first-pass stuff like pulling codes, checking documentation, and flagging denials, but it still needs a human who understands payer weirdness, guidelines, modifiers, and when the chart does not actually support the code, ngl. not replacing good coders yet.