Coder Bias is a Hidden Threat to Healthcare Accuracy. To Fix It, We Need a Tech-Driven Solution


In the ever-evolving landscape of healthcare, the precision of medical billing and coding stands as a cornerstone for efficient healthcare delivery. The use of Current Procedural Terminology (CPT) codes, in particular, plays a critical role in this ecosystem, serving as a universal language that bridges clinical services with billing and insurance processes. However, this system is not without its challenges. One of the most significant issues faced in this domain is coder bias – a subtle yet impactful factor that can lead to inconsistencies and errors in data management. So the question remains: How can healthcare systems effectively address the challenge of coder bias in the use of CPT codes?

Coder bias, often unintentional, arises from the subjective interpretation of medical scenarios, leading to variations in coding practices. Addressing this issue is not just about maintaining financial accuracy; it’s about ensuring the integrity of patient care and resource allocation. To delve deeper into this topic, we turn to an expert in the field, Dr. Arpita Hazra, who serves as a Clinical Patient Safety Data Specialist at Healthcare Risk Advisors. Dr. Hazra highlights the need for enhanced code compliance and the integration of technology to improve data consistency, marking a crucial approach in addressing this widespread issue in healthcare data management.

Dr. Hazra’s Thoughts

“Coders use CPT codes for capturing billing data in the health systems. These codes are also very useful for
analytical purposes, for be it risk data or quality metrics data, data used for research and analytical purposes. A
major struggle when we look at this data is that coder subjectivity, and that’s because, since these codes were
originally made for billing, but their use is more widespread now, so you will see that when we look at the
data, we have struggles with subjectivity pertaining to ICD codes, etc. This requires extra cleaning, extra steps in
the process to make this data more consistent.

Code compliance can be improved in the health systems by exercises like inter-rater reliability, which can be built-in for the coders in their regular workflow. Having these exercises will help create a shared mental model and help them create consistent codes for specific scenarios. Technology can help with reducing coder subjectiveness, and the coders can spend more time in oversight and cross-checking instead of manually entering codes and patient charts.”

Article written by MarketScale.

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