{"id":7506,"date":"2025-08-13T04:46:11","date_gmt":"2025-08-13T04:46:11","guid":{"rendered":"https:\/\/medical-article.com\/?p=7506"},"modified":"2025-08-13T04:46:11","modified_gmt":"2025-08-13T04:46:11","slug":"impact-of-ai-on-healthcare-billing-edition","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=7506","title":{"rendered":"Impact of AI on healthcare: billing edition"},"content":{"rendered":"<p><a href=\"https:\/\/joepaduda.substack.com\/p\/california-comp-drivers-part-1\">Joe Paduda of <\/a><em><a href=\"https:\/\/joepaduda.substack.com\/p\/california-comp-drivers-part-1\">Managed Care Matters<\/a><\/em> discusses rising Workers Comp cost in California:<\/p>\n<p>Of particular interest is the growing prevalence of unlisted codes in physical medicine (PM). Last year saw a huge jump in PM services coded as 97799 \u2013 \u201cunlisted physical medicine\u201d. <\/p>\n<p> Note that jump happened while the use of normal\/traditional\/common PM codes for services including therapeutic exercises and manual therapy\u00a0<em>declined<\/em>.<\/p>\n<p>Oh, and these\u00a097799 codes account for a third of all PM spend in California \u2013 at an average cost of $1700 each. <\/p>\n<p>What are unlisted codes and why do we need them?  <a href=\"https:\/\/www.plutushealthinc.com\/post\/handling-unlisted-codes-strategies-to-avoid-rejections\">PlutusHealth explains<\/a>:<\/p>\n<p><a href=\"https:\/\/www.elsevier.com\/connect\/medical-knowledge-doubles-every-few-months-how-can-clinicians-keep-up\" target=\"_blank\" rel=\"noopener\">Medical science is advancing exponentially<\/a>. New services, devices, and medicines are entering the field quicker than ever before. Unfortunately, the American Medical Association (AMA) may take 18-24 months to modify CPT codes to reflect these advancements. In these circumstances, unlisted codes meet the crucial task of expediting the process of coding and billing. <\/p>\n<p>This seems odd.  While these unlisted codes are highly reimbursed, payers often reject them unless there is extensive documentation around the service performed, the extenuating circumstances, and technical specifications.  <\/p>\n<p>However, with AI, doing all this documentation is much easier.  Are physicians simply entering a description of the services and asking AI to document in such a way that insurance will reimburse?  While I don\u2019t have evidence to say that AI is the reason for the rise in unlisted medical codes, it is true that <a href=\"https:\/\/www.mcpdigitalhealth.org\/article\/S2949-7612%2824%2900041-5\/fulltext\">AI is being widely used for medical documentation<\/a>.   Is AI the explanation or is there another reason?  What do you think?<\/p>","protected":false},"excerpt":{"rendered":"<p>Joe Paduda of Managed Care Matters discusses rising Workers Comp cost in California: Of particular interest is the growing prevalence of unlisted codes in physical medicine (PM). Last year saw a huge jump in PM services coded as 97799 \u2013 \u201cunlisted physical medicine\u201d. Note that jump happened while the use of normal\/traditional\/common PM codes for&#8230;<\/p>\n","protected":false},"author":0,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-7506","post","type-post","status-publish","format-standard","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/7506"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7506"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/7506\/revisions"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7506"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7506"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7506"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}