10 Reasons Medical Coders Are Essential Despite AI

While AI has made significant advancements in healthcare, there are several reasons why it cannot fully replace human medical coders:


Mumbai : Dr. Santosh Gupta, CEO of MEDESUN®, a pioneer in the area of medical coding with 45 certifications and a remarkable 20-year track record, believes that although AI may surely assist medical coders, it is inadequate to replace them. The complexities of medical coding, which need a combination of ability and competence, along with important privacy and security concerns, make overreliance on AI for this sophisticated profession nothing short of a disaster.

The precision of AI-generated codes is determined on the quality and completeness of the incoming data. Incorrect coding might result from mistakes or omissions in patient records.

Medical coding is a complex process that requires clinical expertise, context, and an awareness of the patient’s medical history. The intricate nature of code may cause AI to suffer. Human assistance is often required to guarantee appropriate coding in cases involving complicated or unusual medical problems.

In the case of confusing or incomplete information in medical records, human coders might use their discretion to request clarification from healthcare professionals and resolve coding issues.

standards that are Constantly Changing: Medical coding standards and regulations, such as ICD-10, CPT, and HCPCS, are constantly revised. Human programmers can adjust to these changes, however AI systems must be updated on a regular basis.

Clinical judgement: When assigning codes, medical coders often need to use clinical judgement. AI is incapable of interpreting complicated medical issues and making decisions.

Medical coders often engage with healthcare practitioners to clarify information or seek further facts. AI is lacking in the interpersonal skills required for successful communication. Human coders may perform extensive quality control checks to detect and correct coding mistakes or anomalies. They can also test the precision of AI-generated codes.

Coding for Unusual conditions: Medical conditions that are unusual or distinctive may not fit easily into standard coding systems. While AI may struggle, human programmers can adapt and discover acceptable codes. Medical coders often work with healthcare practitioners to get more information or to resolve coding problems. They create connections that AI cannot.

Error Handling: In circumstances of confusing or contradictory data, human coders may use their discretion to resolve difficulties. AI may make mistakes or need human involvement.

Patient Privacy: Medical coders must handle sensitive patient information with caution and follow HIPAA standards. To preserve data privacy, AI systems need stringent controls.

Human coders may do quality control checks to evaluate and validate codes for correctness. AI systems require constant monitoring and oversight.

Medical coding often incorporates ethical and legal problems that need human comprehension and adherence to ethical norms.

Medical coders must address ethical quandaries such as ensuring that codes correctly represent the medical services delivered while conforming to regulatory restrictions such as HIPAA.

Coding for uncommon Procedures: AI may lack sufficient data on highly uncommon medical procedures to make proper coding recommendations. Human programmers may depend on their knowledge and experience. Human coders collaborate with CDI experts and healthcare professionals to enhance clinical documentation and ensure that codes appropriately depict the severity of disease and the complexity of treatment.

Determining culpability in the case of coding faults or AI-related concerns may provide legal and ethical difficulties. AI algorithms might inherit biases from the data on which they are taught, which could result in biassed coding judgements or inequities in healthcare treatment.

While AI may help medical coders by automating mundane activities and increasing productivity, owing to the intricate and nuanced nature of medical coding, it is unlikely to completely replace them. Instead, AI is likely to augment human coders in the healthcare business to improve accuracy and efficiency.

Mr. KM Sai Ram, a prominent CPC, CHIM®, CPMB – Certified professional medical biller and coder with a strong 5-year background in medical coding, highlights the profession’s highly specialised nature. He emphasises that depending on AI for medical coding is likely to result in a wider margin of error, leading in a terrible conclusion. MEDESUN® offers ICD-11 Coding Training and CHIM® – Certified Health Information Management Programme in India.

MEDESUN® Facts: MEDESUN® Medical Coding Academy, situated in Hyderabad, is a famous school committed to delivering thorough online medical coding courses, ICD-11, and ATC Codes. MEDESUN® provides cutting-edge courses, skilled professors, and hands-on learning experiences, guaranteeing students are well-prepared for successful careers in medical coding and Health Information Management Training in India, the United States, and the United Arab Emirates. The academy’s emphasis on industry-relevant curriculum and cutting-edge coding practises makes it a top option for prospective medical coders looking for excellent education and a career path.

Staying ahead in an age of tough competition and fast breakthroughs in AI technology requires a comprehensive strategy. MEDESUN® understands this need and provides a complete education programme that includes medical coding, medical billing (Certified Professional Medical Biller-CPMB), and CHIM-Certified Health Information Management training. MEDESUN® empowers students with the wide skill set necessary to flourish in the developing healthcare environment and stand out in the highly competitive profession by delivering a 360-degree grasp of these disciplines.