The things we could do with Medical Records, Part II: Decoding Coding

First, a quick primer on how a medical bill is born:

Ok, so basically there are these two mystical players in the center of this huge, bloated, and expensive medical system who you never meet or talk to. How do they do what they do?

  1. Your doctor writes a note that looks like this:
CHIEF COMPLAINT: Pain and swelling in abdomen
HISTORY OF PRESENT ILLNESS: Patient is a 67-year-old female presents to the emergency room with sharp, shooting pain in her lower abdomen and pronounced swelling. Patient is nauseous, has vomited, and has a fever. Abdomen is firm and slightly distended. Patient states she has no history of abdominal problems, disease, or hernia.
PAST MEDICAL HISTORY: Patient is on a program of anti-depressants, but is otherwise physically sound. States she has never been admitted for any abdominal problems.
CURRENT MEDICATIONS: Wellbutrin, 5 mg daily
SOCIAL HISTORY: Used to smoke (using Wellbutrin to quit) and does not drink
Vital Signs:
Blood pressure is 150/88, with a fever of 102 degrees.
Skin: Warm and dry and normal, except in lower abdomen, where it is swollen and tight
Chest: no respiratory problems detected
Cardiac: regular rhythm
Back: No abnormalities detected
Abdomen: is firm above the pelvic bones. Patient experiences pain upon palpation. Blumberg sign elicits painful response, as does a forced cough. Abdomen is tight and swollen.
INTERVENTION: Physical examination suggests appendicitis. Ultrasound test ordered, and diagnosis of appendicitis is confirmed. Patient is rushed to surgery and is prepped for general anesthesia. Once anesthetized, patient receives appendectomy via laparoscopy. Exploration during surgery reveals no signs of peritonitis, local or general. Following surgery, patient is taken to observation room, and then to hospital room. Patient responds well to surgery, and is discharged later that night with a prescription for pain medication.
Diagnosis: Acute appendicitis

2. They turn all that into this:

99284 (E&M)
76705 (Radiology)
44970 (Surgery)
with 00840-P3 (Anesthesia)
540.9 — Acute appendicitis without mention of peritonitis

How long does this take? Best case, a day. Worst case… weeks? Some doctors and hospitals employ outside billing companies. Medical records are sent to the billers in bulk, to be doled out, processed and billed. Good thing they are super accurate and efficient, right? WRONG. In 2014, the Office of the Inspector General discovered that 42% of visit are incorrectly coded.


Truly. We must be able to do better. What if we could look at all medical bills in aggregate, and then all the codes for those bills, and begin to train an algorithm to code in real time as doctors write their notes? It might take some work, and it probably would take a while to get right, but the current standard is 42% accuracy, and these are bills that bankrupt people on a daily basis. It’s worth a shot.

This post is part of a series of explorations of what could happen in the EMR space done as an independent project at Cornell Tech in 2016. 
part 1, part 3, part 4

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