News: AI scribes indicate a shift in coding intensity and reimbursement, new research finds

As ambient listening and artificial intelligence (AI)-enabled scribing technology explodes in healthcare, new studies show a shift in coding intensity which may be linked to the growing adoption of these tools.

First, the Blue Cross Blue Shield Association (BCBSA) and its data analytics partner, Blue Health Intelligence, recently found significant changes in care for maternity cases nationwide. The shift revealed a significant increase in cases coded for acute posthemorrhagic anemia, a serious condition that usually requires blood transfusions. However, patients coded with the diagnosis never received a transfusion or other appropriate treatment.

“Something is disconnected,” said Dr. Razia Hashmi, BCBSA’s vice president of Clinical Affairs. “Among hospitals showing the fastest rise in diagnoses of post-partum anemia, the rise in patients coded with this condition wasn’t paired with the level of care we would have expected, and the patterns we’re seeing point to AI‑enabled coding.”

This disconnect between coding and clinical practice contributed to about $22 million in additional spending from 2023–2024.

“While AI has the potential to reduce administrative burden when used appropriately, the findings underscore the need for greater oversight. BCBSA and BCBS companies are working at both the national and local levels to use data to identify upcoding trends, establish clear expectations for hospitals using AI tools and better align payment with the accurate representation of care delivered,” the study reported.

Beyond maternity healthcare, a second study found increased outpatient coding intensity following hospital adoption of AI scribes. Released by Trilliant Health, a healthcare market intelligence company, the analysis studied national all-payer claims data for evaluation and management (E/M) billing patterns at six large hospitals and health systems from 2018-2024. All of the organizations had publicly announced their adoption of AI scribes and ambient listening technologies.

According to the analysis, there was a "consistent upward redistribution of both new and established outpatient E/M visits toward CPTs 99204-99205 and 99214-99215" across all organizations. Notably, coding for high-intensity new patient E/M visits ranges from 12–20 percentage points to as high as 80% at one health system.

“AI-enabled scribing tools allow clinical documentation to be captured more thoroughly and accurately,” explained the report. “The promise of automating processes with AI is that once a model ‘learns’ the rules, it is less error-prone than humans in performing that task but continues to operate within the bounds of a deterministic coding system.”

“Whether the introduction of AI-assisted scribing is unduly influencing billing practices and systemwide spending is an important question for policymakers,” stated Trilliant Health’s study. “It is incontrovertible that a systemic increase in higher-acuity codes and corresponding decrease in lower-acuity codes would have significant cost implications in the health economy.”

Editor’s note: To read BCBSA’s study, click here. To read Trilliant Health’s study, click here. To read additional coverage and analysis of both studies by TechTarget, click here.