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Lead Moderator

Elisabeth Rosenthal's highly readable new NYT piece illuminates the byzantine practices behind medical billing and coding.

The article tells the story of one uninsured woman who received upwards of $500k in charges for a 3-week hospitalization for a subarachnoid hemorrhage, and the work she did to reach a settlement. It took 2 years of work from lawyers, coders, & others to unravel the coding and charges. (Actual solution: call from NYT reporter about whether trial was open to public.)

Key takeaway for me was: we have a coding arms race that is driving up costs without adding value (Membership in the American Academy of Professional Coders has risen to more than 170,000 today from roughly 70,000 in 2008.) We've discussed elsewhere how prices are untethered from costs, and this piece illustrates how billing and coding practices further distort pricing. Not to mention the administrative waste generated by work required to game codes on the billing side and catch excesses on the payer side.

Are there any policy fixes for our coding quagmire?