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The American Hospital Association (AHA), which represents more than 5,000 hospitals and 43,000 individual members, is an an official exhibitor at the AHIMA20 Virtual Conference. To learn more about the AHA or arrange a meeting with representatives during AHIMA20, please contact Samantha Swift, Marketing Manager; Chabre Ross, Director, Product Management; and Jennifer Gillespie, Product Manager, Billing & Coding.

Artificial intelligence (AI), Machine learning (ML), and Computer-assisted coding (CAC) are all buzz words used in combination with medical coding. In a nutshell, ML (an application of AI) uses algorithms to classify natural language patterns inside documents to assign codes and “learn” from the patient’s encounter through the assigned codes. The development of natural language recognition and algorithms result in CAC tools, which have been around for more than 20 years, Encoder products, and now more enhanced AI-Assisted coding.

It has been reported that AI, CAC, and ML technologies, in different formats, help to reduce complexity and effort on behalf of the coder while providing greater accuracy in clinical documentation. The goal of investing in these technologies in the medical coding and clinical documentation improvement (CDI) fields is to have a complete record of the patient’s medical history, increase the number of charts being coded with greater accuracy, and to recoup revenue. In what way does ML help or harm accuracy, efficiency, and workforce?

Accuracy and Efficiency

Artificial intelligence software tools and systems unquestionably help coders increase speed, accuracy, and efficiency in working with the large number of code sets (over 69,000 ICD-10-CM diagnostic codes and over 70,000 ICD-10-PCS procedure codes). Technology greatly assists coders with identifying the proper codes more quickly than using a codebook, especially when dealing with complex charts. It is not a one-way street, however. While medical coding software improves the speed at which a chart can be coded, an experienced coder is essential when it comes to interpretation of the documentation. In most cases, there is more than one way to code a procedure or diagnosis; a human coder has to decide on the most appropriate code option and use deductive reasoning—something current software does not provide.

Workforce

The medical coder workforce is essential in how healthcare is reported in the United States today, and medical coders will be crucial in improving how AI assists in providing accurate information for medical coding and billing because the systems with which coders interact study their behavior and learn from how they use the systems. The biggest challenge for AI and human interaction with coding patient charts is inaccurate coding in general. ICD-10-CM and ICD-10-PCS guidance and the ability to apply the correct advice and interpret codes correctly is critical to improving the accuracy of coding charts. Medical coders and AI tools must have a harmonious relationship of checks and balances to reduce coding errors.

What Does It All Mean?

Well-trained and experienced medical coders are and will continue to be essential workers within the healthcare ecosystem. They are the access point of ensuring accurate payment for physicians, hospitals, and health systems. Medical coders also are vital in creating an accurate record of patient care history, which is essential to all who have ever found an error in our medical record. Lastly, capturing medical codes serves a purpose on a public health scale with a comparison of initiatives and preparations for underserved healthcare areas, conducting research, support for administrative tasks, as well as recognition of symptoms that need to be tracked for public health. The importance of medical coders to continue educating themselves, stay current on coding guidance, and seek advice from official sources is essential in adhering to applicable coding rules and conventions. While machines continue to get smarter, it is human coders that they are learning from and that allow the technology to further advance so that it can add greater value to the work we humans perform.

Register for AHIMA20

The AHIMA20 Virtual Conference is the premier educational, exhibition, and networking event for health information professionals. Whether you are seeking cutting-edge education, evaluating the latest market innovations, or are seeking new professional connections, the AHIMA20 Virtual Conference is the place to be. Register today.

Chabre Ross, MBA, (cross@aha.org) is director of product management at the American Hospital Association, the national organization that represents and serves all types of hospitals, health care networks, and their patients and communities. Nearly 5,000 hospitals, health care systems, networks, other providers of care and 43,000 individual members come together to form the AHA.

Through our representation and advocacy activities, AHA ensures that members’ perspectives and needs are heard and addressed in national health policy development, legislative and regulatory debates, and judicial matters. Our advocacy efforts include the legislative and executive branches and include the legislative and regulatory arenas.

Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends.

 

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