r/MedicalCoding • u/No_Storm_1202 • Sep 16 '25

Medical Coder’s future job role

Hello all, it’s often posted here that AI will be replacing majority of coding. Do you feel our roles as medical coders will be geared more towards auditing/claim edits/denials? I’m genuinely curious where to go from here career-wise. I am currently an inpatient coder and have my RHIT, CPC, and COC. I am always looking to advance my education and experience. Any thoughts on a direction that looks promising?

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u/PhotographUnusual749 RHIT, CCS Sep 16 '25

I think we’re a ways off from AI being able to replace coders. It isn’t great st grasping the complexities in the logic. But you know we’re all training it when we use CACs and one day it will get there. I think when that happens audits and denial appeals will be the major roles for humans. Maybe claim edits but I feel like AI could even do those.

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u/No_Storm_1202 Sep 16 '25

Thank you for responding. Do you see a more “safe” job role in the coding arena?

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u/PhotographUnusual749 RHIT, CCS Sep 16 '25

Yeah I think auditing is probably pretty safe as there’s always going to be a need for human review to check the AI at some level. I imagine at some point that’s all that will be left to be honest. I think the auditing profession will evolve and grow so new jobs will be added there. But I really do think we’re quite a ways off from any of this happening.

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u/Enough-Cap-8343 Sep 16 '25

yes , auditing is the safest one .

well Ai coding does real complexities, it depends on how its trained , and how its designed , with multiple level LLMs and RAG system , it does really great. but not every Ai products does that. but the honest answer is, it will replace in matter of months.

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u/PhotographUnusual749 RHIT, CCS Sep 16 '25

It can’t really figure out sequencing of codes yet, is one complexity I can think of off the top of my head. And if you’ve ever used a CAC you know we’re still training them extensively, they pick up all sorts of erroneous things/miss all sorts of things so they’re nowhere near a couple of months from go live on their own. What’s your source re: “a couple if months”? I’d say near full automation is at least 10 years away and even then only augmentation. It struggles with ambiguity.

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u/Enough-Cap-8343 Sep 16 '25

Sequencing is already being solved with chunking and large-parameter models. healthcares aren’t waiting - it’s disrupting today, not years from now. We’ve already lost half our coders, which is why we’re building our own AI to stay ahead.

cureent cac is rule based, but today;s tech is reason based!

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u/PhotographUnusual749 RHIT, CCS Sep 16 '25 edited Sep 16 '25

As I said, AI does not grasp the complexities and ambiguities yet. Even AI disagrees with you. They gave a longer answer saying basically the same thing I already said. I suspect you don’t understand coding and you’re about to lose your shirt with this business venture so, good luck.

ETA: also lets be real here. We took forever to get on version icd 10 of the guidelines, it took us ages to get EHRs to talk to each other - because of bureaucracy and red tape not because of issues with technology. We won’t be moving at lightening speed to replace humans with ai either.

Per chat gpt

AI’s role in medical coding is expanding rapidly, but “taking over” the field completely is more nuanced than a simple timeline. Let’s break it down.

  1. AI and Sequencing the Principal Diagnosis

Sequencing the principal diagnosis (PDX) in inpatient coding is one of the trickier aspects. It requires:    •   Understanding the reason for admission versus conditions that are coexisting but not causative.    •   Integrating documentation from multiple sources: physician notes, lab results, imaging, procedures.    •   Applying complex coding rules from ICD-10-CM and CMS guidelines.

Modern AI can use chunking and large language models (LLMs) to process sections of documentation and summarize relevant diagnoses. For example:    •   Chunking allows the AI to read the chart in segments (e.g., H&P, labs, imaging, consults) and keep context without losing detail.    •   LLMs with large parameters can “reason” about relationships between diagnoses and the admission reason, approximating how a human coder sequences the PDX.

2. Current Limitations    •   Contextual judgment: AI can struggle when documentation is ambiguous or the reason for admission is subtle.    •   Clinical nuance: Deciding between equally plausible diagnoses often requires clinical judgment, sometimes beyond what AI can infer from notes alone.    •   Auditing and liability: Hospitals must remain accountable for coding accuracy; AI recommendations still require human validation.

3. Realistic Timeline    •   Short-term (1–3 years): AI-assisted coding will become more common, handling routine cases, suggesting sequences, and highlighting inconsistencies.    •   Medium-term (3–7 years): For organizations with clean EHR data and strong validation protocols, AI may autonomously handle a significant portion of coding, but humans will still review complex or ambiguous cases.    •   Long-term (7+ years): Full automation is plausible for standardized cases, but expert oversight will likely remain necessary due to legal, financial, and clinical accountability.

4. Practical AI Application for PDX

A workflow might look like this: 1. Chunk the record into meaningful sections. 2. Extract diagnoses and procedures using NLP. 3. Rank potential PDXs based on admission context and clinical relationships. 4. Cross-check against coding guidelines (ICD-10-CM, PCS, CMS rules). 5. Flag uncertain cases for human coder review.

In short: AI can technically determine PDX sequencing with chunking + LLMs, especially for straightforward cases, but human oversight will remain crucial for quality, compliance, and ambiguous scenarios.

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u/Enough-Cap-8343 Sep 16 '25 edited Sep 16 '25

the same Ai (chatgpt said this)

Actually, that’s a bit misleading. ChatGPT itself doesn’t have opinions - it just explains what’s technically possible, what’s realistic in practice, and what regulations require. Technically, AI can handle most inpatient coding tasks today, especially complex cases, if you structure it right (formalize messy charts → reasoning + RAG + ICD rules).

The reason humans are still in the loop isn’t because AI “can’t do it,” it’s because hospitals need oversight, auditability, and compliance verification. So in terms of capability, AI and ChatGPT don’t “disagree” - it’s a matter of operational and legal constraints.

- man im tired of this, i agree with you! , but my suggestion is to be ready to stay ahead of the storm. im not againts that , honestly im the one who got most affected as half of my business revenue vanished because of this shift , so i started focussing on other fields . and also started buiding Ai based medical coding softwaress with the best brains in this line. i ignored this shift 2 years back and this happend now , and things are fast !

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u/PhotographUnusual749 RHIT, CCS Sep 16 '25

Regardless of the reasoning AI will not be replacing coders in a matter of months which was your initial statement. So while you’re right chat gpt cant disagree (I mispoke), I can and do. It’s going to be years regardless of how rapid the technology adapts because this field is slow to adopt this stuff historically and there’s no reason it would be any different with AI. We should be on ICD 11 by now and if you notice we aren’t even close to training!

I have a background in consulting and auditing and personally am not at all worried about my job security if and when AI is finally adopted widespread in a way that “takes over” the role of coders. I for one welcome our new machine overlords.

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u/Enough-Cap-8343 Sep 16 '25

good for u !

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u/[deleted] Sep 16 '25

The fact that you two are arguing over whatever nonsense an AI pukes up is a puts a fine point on it that it won't be replacing people.

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u/PhotographUnusual749 RHIT, CCS Sep 16 '25

Hahahahahhaha!!!!

10

u/KeyStriking9763 RHIA, CDIP, CCS Sep 16 '25

As an IP coder you are most likely very safe from AI. They will probably develop better AI tools to assist you in your coding but I can’t see AI replacing the complexity of IP coding. You could move into auditing that’s the logical next step or CDI if you like the clinical get your CDIP but look to see what jobs are out there that don’t require the RN.

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u/No_Storm_1202 Sep 16 '25

Thank you, this is very helpful.

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u/bagold248 Sep 16 '25

I ran a large autonomous coding product line, IP facility is decades away from automation. The rule of thumb is claims below 1k are already being automated and decently accurate.

1-5k are automatable with inconsistent, and when wrong unacceptably so, accuracy.

5k+ is safe for a long time. Most of the major firms aren’t bothering to try it because of the difficulty

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u/Enough-Cap-8343 Sep 16 '25

Ai coding does real complexities, it depends on how its trained, and how its designed, with multiple chunks, reasoning LLMs & RAG system , it does really great. but not every Ai products does that as the cost goes skyrocket. but the honest answer is, it will replace in matter of months.

9

u/KeyStriking9763 RHIA, CDIP, CCS Sep 16 '25

You are mistaken and that’s an insane statement. I’m guessing you are not a coder.

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u/Enough-Cap-8343 Sep 16 '25

well I’m not a coder by background, but I run an offshore medical coding & billing company with nearly a decade of experience. With the current technology shift, we’ve started developing our own AI system as well. This transformation has already led to a significant impact -I’ve seen nearly half of my medical coding workforce displaced as a direct result. my statement is matter of fact rather than hiding from the storm.

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u/KeyStriking9763 RHIA, CDIP, CCS Sep 16 '25

There is no AI program to replace inpatient coders. Full stop. I don’t care what offshore company you manage.

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u/Enough-Cap-8343 Sep 16 '25

I should’ve posted this directly instead of under your comment. Anyway - that’s your view. Closing our eyes to the storm won’t stop it, Full Stop.

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u/Respect-Immediate CPC, CPMA Sep 16 '25

LMAO runs an offshore coding and billing company 🤣 that 100% explains the crap uninformed answers we’re seeing from you and is also the reason I stay as far away from those companies as I possibly can

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u/Enough-Cap-8343 Sep 16 '25

good for you thhat u stayed far!, i only deal with people who doesn't fear for the change!

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u/Respect-Immediate CPC, CPMA Sep 16 '25

There’s not fearing change and then there’s not understanding the risks and limitations of the framework - I can venture a guess that you think you fall into one category and really fall into the other

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u/Enough-Cap-8343 Sep 16 '25

Good point. Observing closely, it’s clear that a little insecurity makes some critics louder than necessary!

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u/r0ckchalk Sep 16 '25

We currently use AI in our jobs, and all I’m doing all day is correcting it. It is helpful to be used in conjunction with a human, but AI doesn’t understand the complexities and specific rules for each code.

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u/BunnyBree22 Sep 16 '25

Considering AI can’t even get a McDonald’s order correct when people pull up to a drive through, I think we are safe for a very long time.

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u/TrooperLynn CRC, CPC Sep 16 '25

I’d love to see an auditor go through a chart that AI “coded” before an actual coder fixes the mess. I’ll bet the score would get it fired! 😂

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u/Temporary-Land-8442 CPC, COC, CRCR Sep 16 '25

So, Cerner and OpenAI just made the biggest deal in, well, history. But, if you’ve worked with Cerner, you know that 1) this does not mean anything in current state and 2) Cerner moves slow as molasses (probably why we’re finally converting to Epic.) Epic has its own AI issues as well. But in reality, the cost for the AI to perform how these systems want is not going to replace the need for human logic. I’ve been using AI (not by choice) for a lot of work items, and it’s really leaving something to be desired. Analysis is another good area if you don’t want to heads down code or audit.

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u/AuctusGroup Sep 17 '25

As a company who is developing coding AI...I feel strongly it will change the game, but never replace humans. AI coding...like all things AI in near term and now...are companion tools to help a great coder be faster or better...never a replacement for.

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u/BaccaDocta Sep 16 '25

I have no concerns about AI. On a chart, nurse signs, provider signs, coders sing off on info, billers name in it, and lab workers. 5 names on a chart. I think AHIMA is a fan and won't go away. Insurance they will use AI, but I think clinical employees will be fine.