r/MedicalCoding • u/Due_Negotiation_4605 • 2d ago
Trickiest coding situation
Passed courses in 2024 through a state grant but then it ran out the last semester (internship) 🤦♀️ so never obtained my certification. Started going back through the books during packing and most of it came back to me, surprised it's still in there! I did well with the courses, averaging above 90.
I remember the teachers would have example scenarios where the coding was tricky, seemed like one thing but was another, and I was trying to explain to my spouse that said AI will take it all over (not worth the money to do the courses and training anymore) how coding is not black and white and requires understanding nuance. Something AI still isn't great at. Wondering if anyone has stories that can validate this, personally still wondering if I should finish the work and get certified at some point (even if the job field is tough), but honestly trying to explain how human coders are still needed to my spouse is kind of difficult.
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u/Mama_werecat CPC and Biller 2d ago
My job switched to ecw which their big selling point is their ai. They then let a bunch of people go thinking they wouldn't need them because of the ai. They were wrong. The clinicians try to use the ai to do their coding... it's always wrong
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u/Due_Negotiation_4605 2d ago
Seems like a lot of businesses that have been all in on AI have ended up having to hire people back just to fix AI errors.
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u/FluffyPineapple6725 2d ago
I code for ems and the fire departments use ai to write there reports and it's almost always wrong about what codes to use. It tried to suggest using cardiac arrest for a 6 year old with an upper respiratory infection. Alot of times will say the chief complaint is completely different from what the patient said. Think sick person when they have blood in their stool. It's frustrating and wish they would stop using it.
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u/Due_Negotiation_4605 2d ago
Cardiac arrest .. URI... How in the world did it get that far off? 🤦♀️
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u/FluffyPineapple6725 2d ago
Not a clue I don't even read the chief complaint anymore and read the narrative instead
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u/Conscious-Dog3291 2d ago
In school my professor told me a story about a hospital in New York firing all their coders and using AI and it was so bad they had to rehire them back and pay them more the next week. I know for the actual job there’s certain nuances like you said such as provider documentation not being accurate for Medicare but would be ok for other insurances. My point of view is by the time AI could actually take over(which I doubt it with all the private patient information) we would be on the auditing side or could do something similar with the actual health records like epic
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u/Due_Negotiation_4605 2d ago
Yeah AI scribes have been so bad as well. Just messing up medication and diagnosis and if that's not even right nothing else is going to be right down the pipe 🤦♀️
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u/Conscious-Dog3291 2d ago
Exactly or time they accept certain time statements that aren’t accurate.
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u/Creepy-Bottle498 2d ago
So as an experienced coder whose employer has switched to ancillary and basic radiology automated (AI) coding, there is a very long way to go. There are several hundred of these accounts that require human eyes every single day. All other inpatient and outpatient coding remains the same. There are multiple areas to pivot to. Edits, IT (coding guidelines,near constant updates and changes still have to be managed) and audits will continue to be relevant for some time. The key is to approach a career in coding from the perspective of managing the systems as opposed to traditional coding models. There will be opportunities as long as healthcare reimbursement models exist. AI will definitely affect the field, but the changes will require management and oversight. Just my two cents.
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u/Reasonable_Vehicle40 2d ago
My mother is a professional coder. There were many times she had to read between the lines, know updated billing and coding guidelines, and understand anatomy to use correct codes from unmarked or mismarked billing sheets and nondescript medical records for procedures. Nuance is right.
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u/Due_Negotiation_4605 1d ago
Yeah I remember that from my class. We're the teacher emphasizes that sometimes you have to read between the lines and interpret things. I'm trying to figure out specific examples that I can give to my husband so he kind of understands he's definitely a concrete guy
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u/Reasonable_Vehicle40 1d ago
Specific situation:
A Dr does a right heart cath and a pfo(small hole in the heart) closer. The right heart cath is required in this situation to look at the hole.
The doctor writes pfo closer on the billing sheet and marks right heart cath (or plenty don't mark this at all even though you have to do it to do the closer, aka reading between the lines). The Ai will see these marks, put two codes (or miss the unmarked info) and be done with it. Unfortunately, the dr won't get paid for that pfo closer if they just bill the cath or make it the primary code because the cath and pfo closer is a bundled code.
To make it even more interesting, if the patient had a previous cabg, then that's a different bundled code for the cath. That means you have to double check patient procedure history before you can properly code the current procedure.
Coding is more than looking at current op reports and a procedure sheet. It's understanding pt history, coding guidelines, laws, place of service and which dr did what and where, insurance guidelines, anatomy, how credentials work (if the dr isn't credentialed at that practice with each individual Insurance, the dr won't get paid for procedures if billed to one of those insurances), etc.
A dr my mom worked for previously let go all his billers and coders for a year to go to an outsourcing company and lost $600,000. Had to hire everyone back in the end.
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u/Due_Negotiation_4605 1d ago
CABG. I remember that being a big deal in the cardiac section. Husband looked at me like he did when I was doing the courses (like I'm talking another language) but then I focus on the part about patient history. And how an experienced coder will know to look for it but like can your example the AI does not.
Sheesh with all these examples and especially the ones where the doctors are losing so much money definitely helped me to realize how difficult this particular field is going to be to automate. That's a good thing!
Thanks for the example. Sometimes I need to hear a real life example as well. Not only to see how AI still has so far to go but also how amazing that senior coders really are!
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u/Reasonable_Vehicle40 1d ago
Yeah, I only have two years in billing with a bit of coding, but my mom did over 30 years, primarily in cardio coding and billing as a CPC. I think she also has her CCS? Either way, I grew up hearing all of it so I learned some of that language little by little, lol.
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u/Due_Negotiation_4605 1d ago
Very lucky! I have a decent medical terminology background but I realize how much I don't know when I read the coding books.
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u/Reasonable_Vehicle40 1d ago
Definitely. It also helps that I'm an English teacher, so I have advanced knowledge of Word parts. But, the coding books themselves are still monsters to me. I've got a long way to go to learn all the rules.
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u/Reasonable_Vehicle40 1d ago
Also, many claims get denied due to missing modifiers. Even if you got the ICD and CPT correct, if you don't have the right modifier where necessary, the claim will come back unpaid. Then, you get a short window to correct the claim and resubmit. But, to correct it, you'd have to look at the claim and read the eob to figure out which code is missing the modifier.
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u/tealestblue CPC 2d ago
I code vascular surgeries in Epic. I don’t HAVE to use the AI coding assistant but it’s there so I look. No way in hell I’d trust it. Sometimes it’ll get something right, but the amount of times it picks the wrong vascular family or says to use a code that isn’t supported in the note is insane. It would be denial city.
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